m 


NERVE   WASTE 


NERVE  WASTE 

PRACTICAL  INFORMATION  CONCERNING 

NERVOUS   IMPAIRMENT  IN   MODERN  LIFE 

ITS 

CAUSES,  PHASES    AND  REMEDIES, 

WITH  ADVICE   ON  THE 

HYGIENE  OF  THE  NERVOUS  CONSTITUTION 


BY  H.  C.  SAWYEft,  M.D. 


SECOND  EDITION 


SAN  FRANCISCO 

THE   BANCROFT   COMPANY 

1889 


H 

S3 


WOLOGt 

UBRARV 


Entered  according  to  Act  of  Congress  in  the  Year  1889,  by 

H.   C.   SAWYER 
In  the  office  of  the  Librarian  of  Congress  at  Washington 


PREFACE  TO   THE   SECOND   EDITION 


The  second  edition  of  this  little  book  has  been  wholly 
re-written  and  considerably  enlarged  in  an  effort  to  make 
it  more  practically  useful. 

The  author  shall  be  glad  if  this  effort  to  improve  upon 
his  first  work  will  be  considered,  in  one  sense,  a  grateful 
response  to  the  kind  words  of  the  press  and  to  the  appre- 
ciation of  the  public  toward  the  earlier  edition. 


BAN   FRANCISCO,    JAOTARY,    1889. 

1320  MARKET  STREET. 


260169 


INTRODUCTION 


The  true  scope  as  well  as  the  powers  and  the  limita- 
tions of  the  medical  man  are  often  imperfectly  under- 
stood ;  the  various  functions  of  the  physician — cure,  alle- 
viation, prevention,  teaching — are  better  defined  by  the 
L,atin  cura,  care,  than  by  its  derivative,  cure,  in  its  modern 
sense.  To  care  for  the  health  of  the  whole  community 
is  a  far  wider  field  of  usefulness  than  to  cure  the  sick  in- 
dividuals in  it. 

In  his  work  of  curing,  the  physician  is  too  often  viewed 
as  a  kind  of  sorcerer,  and  he  is  invoked  to  use  the  mys- 
terious chemical  substances  which  he  is  supposed  to  have, 
or  which  he  ought  to  have ;  many  persons  imagine  that 
if  they  could  get  hold  of  the  doctor's  prescription-book, 
they  could  do  without  the  doctor. 

There  are  drugs  whose  action  is  so  sure,  and  surgical 
and  other  procedures  whose  results  are  so  radical,  that 
they  appear  almost  magical,  but,  in  the  large  proportion 
of  cases,  the  physician  is  far  from  being  a  magician,  and 
has  no  absolute  power  over  disease.  He  is  simply  one 
learned  in  the  science,  and  experienced  in  the  manage- 
ment of  sickness ;  he  is  one  factor,  the  chief  of  all  the 
forces  operating  for  life  and  against  death  ;  the  patient, 
his  surroundings,  his  friends — sometimes  his  ancestors — 
influence  the  result  for  good  or  for  evil. 

The  power  of  the  physician  against  disease  and  death 
lies  in  his  trained  faculty  of  observation,  in  his  superior 
insight,  in  his  comprehensive  grasp  of  principles,  in  his 

(vii) 


VIII  INTRODUCTION. 

profound  knowledge  of  all  the  conditions  which  are  for 
and  against  life,  in  his  wiser  judgment,  and  in  the  author- 
ity or  the  influence  which  he  is  able  to  excercise  in  any 
particular  case.  These  qualities  often  enable  him  to 
nurse  the  flickering  flame  of  life  into  health  and  strength 
where  a  less  skillful  hand  would  extinguish  it  forever. 

lyike  the  architect,  the  ship-master  and  the  general,  the 
doctor  is  a  director  of  forces,  a  supervisor,  an  exerciser 
of  good  judgment;  his  equipment  is  intellectual  more 
than  physical;  his  power  to  cure  is  oftener  in  his  head 
than  in  his  satchel. 

It  is  to  be  feared  that  the  physician  has  sometimes  per- 
mitted or  encouraged  an  exaggerated  estimate  of  his 
power;  he  is  human,  and  when  the  case  gets  well  he  has 
not  the  heart  to  dispel  the  illusion  which  inspires  such 
grateful  praises.  Perhaps  he  feels  that  these  are,  in 
some  measure,  his  due  to  offset  the  unjust  criticism  which 
all  physicians  receive.  But,  in  the  end,  any  mistaken 
idea  of  his  power  is  apt  to  react  upon  the  physician. 
When  he  fails  to  save  a  case,  which  no  power  on  earth 
could  save,  he  is  at  fault;  he  did  not  understand  the  case; 
he  did  not  know,  as  he  ought,  the  specific  for  this 
particular  disease.  The  interests  of  both  the  physician 
and  his  clients  are  best  served  by  an  intelligent  compre- 
hension of  the  scope,  the  powers  and  the  limitations  of 
medical  science. 

The  cure  of  disease  will  always  be  an  important  ele- 
ment of  the  physician's  work,  and  in  the  incurable  sick, 
the  alleviation  of  pain,  the  prolonging  of  life,  the  affording 
of  euthanasia  are  priceless  services;  but  the  most  valuable 
services  which  scientific  medicine  is  capable  of  rendering, 
lie  in  the  direction  of  disease-prevention — in  the  family, 
in  the  state  and  in  the  nation. 

At  this  time  the  policy  of  preventing  disease  rather 
than  curing  it  is  not  generally  understood  nor  appre- 
ciated, but  the  world  is  rapidly  growing  too  wise  to  neg- 


INTRODUCTION.  IX 

\V  r 

. 

lect  a  great  conservative  power  in  its  midst,  and  in  the 
future  this  function  of  the  medical  profession  will  be  more 
and  more  utilized.  A  ship  drifts  under  full  sail  upon  a 
tropic  sea,  a  glimmering  cloud  appears  upon  the  horizon, 
nothing  is  done;  the  cloud  grows,  but  is  still  unheeded; 
soon  the  storm  bursts  with  terrible  fury,  a  wild  rush  is 
made  to  take  in  sail,  but  it  is  too  late.  This  would  be 
criminally  bad  seamanship,  but  it  is  an  illustration  of  what 
occurs  every  day  upon  the  uncertain  sea  of  life. 

The  efficiency  of  medical  men  will  be  immensely  in- 
creased when  their  relation  to  their  families  is  more  or 
less  constant,  instead  of  intermittent  and  irregular.  The 
doctor  should  come  and  go  like  the  clergyman  and  the 
priest.  Instead  of  being  a  necessary  evil  whose  visits  are 
avoided  as  long  as  possible,  and  which  are  a  source  of 
uneasiness  when  necessarily  multiplied,  he  should  be  a 
minister  and  guardian  of  health,  an  officer  of  the  family 
upon  whose  special  wisdom  free,  early  and  constant 
reliance  is  placed.  His  counsel  should  have  great  weight 
in  a  hundred  personal  and  family  questions  which  influ- 
ence the  most  symmetrical  development  of  the  child  and 
the  preservation  of  the  man. 

The  eradiction  of  inherited  tendencies  to  disease,  the 
direct  improvement  of  the  physical  and  mental  measure 
of  stocks,  the  development  of  a  hardy  constitution  in 
weak  children,  the  recognition  and  arrest  of  many  fatal 
organic  diseases  in  their  incipiency,  before  they  are  too 
old  to  be  controlled,  the  arrest  of  acute  inflammations  at 
a  time  when  this  is  possible,  the  insuring  of  longevity 
and  a  sound  old  age — these  are  some  of  the  things  which 
the  physician  of  to-day  is  able,  but  which  he  is  not  often 
permitted,  to  do. 

Teaching  is  an  important  function  of  the  physician; 
every  earnest  medical  man  is  '  'doctor' '  in  deed  as  well 
as  in  name.  Medical  advice  in  the  abstract  is  often  barren 
of  influence;  medical  teaching,  which  conveys  clear  ideas 


X  INTRODUCTION. 

of  pertinent  physiological  and  scientific  facts,  is  far  more 
impressive  and  fruitful.  As  in  all  teaching,  the  living 
voice  is  effective  in  a  greater  degree  than  the  printed  page 
can  ever  be;  the  talent  which  some  physicians  have  for 
clearly  illustrating  a  subject  or  emphasizing  a  fact  is  an 
important  element  in  their  success. 


Most  medical  men,  according  to  their  tastes  and  ex- 
periences, come  to  have  a  peculiar  interest  in  certain 
diseases;  such  an  interest  the  author  has  long  felt  toward 
functional  diseases  of  the  nervous  system. 

Nervous  impairment  is  one  of  the  most  common  de- 
partures from  health;  it  is  a  subject  upon  which  consider- 
able teaching  has  been  expended,  some  of  it  true,  much 
of  it  false.  The  experience  of  the  author  is  that  the 
popular  ideas — at  least  upon  the  subject  of  remedies — are 
frequently  vague  or  erroneous;  he  is  constantly  meeting 
with  persons,  in  the  field  of  his  daily  work,  to  whom  a 
realization  of  some  of  the  facts  attempted  to  be  explained 
herein  would  be  priceless;  and  he  has  thought  that  this 
short  statement  from  the  point  of  view  of  a  working  phy- 
sician might,  in  some  degree,  serve  a  useful  purpose. 

SAN  FRANCISCO,  DECEMBER,   1887. 

1320  MA.RK.ET   STREET. 


CONTENTS 


Page 

I.  THE    PHYSIOLOGY   OF   NERVE   FORCE I 

II.  THE    CAUSES   OF   NERVOUS   IMPAIRMENT 6 

III.  THE  CAUSES  OF  NERVOUS  IMPAIRMENT  (  Conj'cT)  1 6 

IV.  TYPES   OF     NERVOUS   IMPAIRMENT 21 

V.  SURFACE     SIGNS 27 

VI.  MENTAL     SIGNS 32 

VII.  CIRCULATION    SIGNS 37 

VIII.  SENSATION   SIGNS 4! 

IX.  MUSCULAR    SIGNS WRITER'S   CRAMP 49 

X.  MUSCULAR  SIGNS THE  CONVULSIVE  DISORDERS  53 

XI.  RESPIRATORY  SIGNS HAY  FEVER  AND  ASTHMA  58 

XII.  ABDOMINAL    SIGNS NERVOUS   INDIGESTION....  6l 

XIII.  RECTAL    SIGNS— CHRONIC  CONSTIPATION 67 

XIV.  REPRODUCTIVE  SIGNS SEXUAL  NEURASTHENIA  69 

XV.  SEXUAL   NEURASTHENIA    IN   THE    FEMALE ....  78 

XVI.  NERVE    WASTE    AND    LONGEVITY 8 1 

fxi) 


XII  CONTENTS. 

Page 

XVII.      THE    CURE    OF   NERVOUS   IMPAIRMENT 84 

XVIII.       REST    AS   A   REMEDY 90 

XIX.      THE    OUTING     CURE 98 

XX.       BRAIN   AND   NERVE    FOODS IO6 

XXI.      TEA,    COFFEE,    TOBACCO   AND   ALCOHOL 115 

XXII.      NERVINES   AND   NERVE     TONICS 119 

XXIII.  DRUG   VICE    AND   MEDICINE    HABIT 129 

XXIV.  ELECTRICITY   AS   A   REMEDY 140 

XXV.       SURFACE    REMEDIES BATHS,  HEAT  AND  COLD, 

COUNTER-IRRITATION,  MASSAGE,  CLOTHING.  .  145 

XXVI.      THE    SURGICAL   TREATMENT    OF    NERVOUS    IM- 
PAIRMENT    155 

XXVII.      APHORISMS  IN  NERVOUS  IMPAIRMENT.. 158 


THE  PHYSIOLOGY  OP  NERVE  FORCE 

THE  NERVOUS  SYSTEM. — The  central  nervous  system 
consists  of  the  brain,  a  soft  mass  of  gray  and  white  tissue, 
which  fills  the  cavity  of  the  skull,  and  the  spinal  cord,  a 
white  cord*  sixteen  inches  in  length  and  about  the  thick- 
ness of  a  lead  pencil,  which  is  enclosed  in  the  bony  spine. 

To  the  anatomist  and  microscopist  this  nerve  tissue  ap- 
pears exactly  alike  in  all  human  beings,  but  the  invisible 
physical  differences  which  undoubtedly  exist  constitute 
the  difference  between  the  mind  of  a  Napoleon  or  a  Crom- 
well and  that  of  some  contemporary  simpleton.  This 
central  nervous  system  communicates  with  every  other 
part  of  the  body  by  means  of  long,  white  conducting  nerves 
of  varying  thickness.  The  term  '  'nerve-cell' '  is  used  quite 
frequently  in  this  book  and  it  is  important  to  understand 
what  it  means.  The  cell  is  the  anatomical  basis  of  human 
flesh ;  it  is  a  minute  mass,  spheroidal,  ovoid,  cylindrical, 
sometimes  shapeless.  A  typical  cell  consists  of  an  outside 
membrane,  and  an  enclosed  mass  of  protoplasm,  which 
may  or  may  not  include  certain  germinal  spots,  the  nu- 
cleus and  the  nucleolus.  These  cells  are  extremely  small ; 
it  is  estimated  that  the  spinal  cord  alone  contains  many 
millions  of  them.  An  aggregation  of  these  cells  is  called  a 
nerve-center,  and  these  nerve-cells  and  nerve-centers,  bound 
and  woven  together  by  fibres,  and  the  crevices  packed 
with  fat  and  connective  tissue,  make  up  the  structure 
known  as  the  brain  and  spinal  cord.  Besides  this  central 

nervous  system,  a  vast  number  of  nerve-cells  and  nerve- 

(i) 


* 


2  NERVE    WASTE. 

centers  have  been  placed  in  the  head,  in  the  neck,  and  in 
the  cavities  of  the  chest,  abdomen  and  pelvis ;  these  cells 
are  independent  of  the  will  but  are  dependent  upon  the 
central  nervous  system  for  their  vitality.  They  control, 
regulate,  and  supply  power  to  the  vital  organs  within  the 
body  ;  they  act  as  reservoirs  of  nerve-force,  and  with  their 
connecting  nerves  make  up  what  is  known  as  the  sympa- 
thetic nervous  system. 

THE  FUNCTIONS  OF  THE  NERVOUS  SYSTEM  are: 
i. — Mind,  Perception,  Intelligence,  Bmotion,  Will. 

2.  Instinctive  Action^  inherited  ability;  a  new-born  in- 
fant almost  without  mind  does  many  acts  instinctively. 

3.  Automatic  or  habitual  action.     Many  acts  come  by 
repetition  to  be  automatic,  done  without  the  consciousness 
of  the  individual,  or  participation  of  mind;  thus,  in  writing, 
the  mind  of  an  adult  is  not  often  concerned  in  the  spelling 
of  the  words,  nor  in  the  penmanship — they  have  become 
automatic  acts;  or,  one  may  play  correctly  a  tune  upon  a 
musical  instrument  while  the  mind  is   absorbed  in  some 
other  subject.     This  principle  of  habitual  action  has  an 
important  bearing  in  nervous  diseases.     Every  repetition 
of  any  act  makes  a  certain  impression  upon   the   nerve- 
centers  in  the  brain  or  cord  which  renders  subsequent 
acts,  more  and  more  easy;  this  is  the  history  of  all  skill, 
from  learning  to  walk  to  the  most  difficult  performances 
of  the  musician  or  the  professional  gymnast. 

Thus  by  repetition  bad  habits  as  well  as  good  ones 
become  established  or  fastened  upon  us,  and  certain 
diseases,  as  epileptic  fits  or  St.  Vitus'  dance  in  children, 
tend  to  become  more  and  more  a  habit,  or  easily  per- 
formed act  of  the  nervous  system. 

4> — Reflex  Action.  By  this  we  mean  that  a  sensation 
in  any  part  is  carried  to  the  spinal  cord  or  brain  by  the 
nerves,  and  thence  reflected  to  some  other  organ  or  part 
by  instinctive  action  or  otherwise.  A  man  touches  a  hot 
iron  and  draws  his  hand  away  almost  before  he  is  con- 


THE   PHYSIOLOGY   OF   NERVE    FORCE.  3 

scious  that  the  iron  is  hot;  the  painful  impression  is 
telegraphed  to  certain  nerve-centers  in  the  spinal  cord, 
and  instantly  they  telegraph  back  to  certain  muscles, 
which  withdraw  the  hand  from  the  iron.  The  mind 
may  not  be  concerned  at  all  in  this  process;  when  a  person 
is  tickled  during  sound  sleep  he  may  make  a  great  variety 
of  reflex  motions,  without  being  at  all  conscious  of  them. 

5. —  The  Nutrition  and  Growth  of  every  tissue  and 
organ  is  under  the  direct  control  of  certain  nerve-centers 
in  the  brain  and  spinal  cord;  every  tissue  is  believed  to 
have  its  "tropic  center"  and,  if  this  becomes  diseased, 
the  nutrition  of  the  parts  dependent  upon  it  suffers, 
— partial  or  complete  atrophy  results.  Many  obstinate 
diseases  of  the  skin  and  of  the  joints  depend  upon  disease 
of  their  nourishing  nerve-centers. 

6. — Certain  areas  of  the  nervous  system  directly  control 
and  regulate  the  circulation  of  the  blood;  this  vaso- 
motor  function  of  the  nervous  system  will  be  more  fully 
described  in  a  future  chapter. 

7.  — The  processes  of  secretion  and  excretion  are  directly 
maintained  and  regulated  by  the  nervous  system;  this 
excito-secretory  function  explains  why  the  mouth  of  a 
hungry  man  waters  at  sight  or  thought  of  savory  food, 
how  tears  well  up  under  the  stimulus  of  emotion,  and 
why  the  secretion  of  the  digested  juices,  and  the  conse- 
quent appetite  and  digestion,  is  influenced  by  good  or  bad 
news,  or  why  the  skin  and  mouth  sometimes  become  dry 
and  parched  under  the  influence  of  any  intense  emotional 
excitement. 

8. — The  nervous  system  acts  as  a  battery  to  gener- 
ate and  give  out  force  to  every  part  where  there  are 
muscular  fibres  ;  the  muscles,  arteries  and  veins,  stomach 
and  bowel  walls,  and  every  organ  that  contains  muscular 
fibres,  gets  that  quality  which  we  call  tone,  from  the 
steady,  gentle  force-supply  from  the  nervous  system. 
Muscular  exertion  involves  the  expenditure  of  nerve-force; 


4  NERVE    WASTE. 

the  power  is  manifested  in  the  muscles,  but  it  comes  from 
the  nerve-cells,  just  as  the  power  which  is  manifested  in 
the  ringing  of  an  electric  bell  comes  from  the  cells  of  the 
galvanic  battery ;  the  champion  oarsman  is  not  the  man 
with  the  largest  or  hardest  muscles,  but  he  whose  nervous 
system  can  supply  the  largest  amount  of  force  and  main- 
tain it  the  longest  in  the  race. 

9. — The  brain  receives,  assorts,  distributes  to  its  differ- 
ent parts,  and  registers,  impressions  and  sensations  from 
every  part  of  the  body,  but  although  the  brain  feels  for 
the  whole  body,  it  cannot  feel  for  itself;  surgical  operations 
upon  the  brain-tissue  cause  no  pain.  When  a  pin  is 
thrust  into  the  finger  the  pain  is  really  felt  in  the  brain ; 
the  proof  being  that  if  the  nerve  which  connects  the  finger 
with  the  brain  be  cut,  the  pin  can  cause  no  pain  ;  the 
finger  is  numb  and  paralyzed.  The  nerves  may  be  com- 
pared to  telegraph  wires;  they  transmit  nervous  impulses 
from,  and  impressions  to,  the  brain  and  spinal  cord. 

THE  SOURCES  OF  NERVE-FORCE. — The  power  that  is 
expended  with  every  thought  and  movement  comes  from 
food  and  oxygen.  The  blood — liquefied  and  digested 
food — circulates  through  every  tissue  and  brings  to  every 
cell  and  fibre  the  chemical  materials  with  which  it  may 
renew  itself;  it  also  brings  oxygen  in  little  red  sacs,  which 
unites  chemically  with  the  worn-out  elements  of  the 
tissues,  burns  them  up,  or  oxidizes  them ;  in  this  body- 
combustion  heat  is  evolved,  and  this  heat,  by  a 
mysterious  vital  process,  is  converted  into  force,  with 
which  every  brain  and  nerve-cell  is  more  or  less  charged. 
This  force  may  be  cempared  to  electricity  and  the  nerve- 
cell  to  a  Leyden  jar. 

THE  RELATION  OF  SLEEP  TO  NERVE  FORCE. — During 
the  day  the  expenditure  of  brain  and  nerve  force  in 
thinking,  moving,  working,  is  greater  than  the  capacity 
of  the  nervous  system  to  store  it  from  the  blood,  so,  after 
sunset,  a  halt  is  called  for  sleep.  During  sleep  the  ex- 


THE    PHYSIOLOGY    OF    NERVE    FORCE.  5 

penditure  of  nerve- force  is  reduced  to  a  minimum,  and 
income  is  far  in  excess  of  outgo;  man  awakens  after  a  good 
night's  sleep  with  his  nerve-cells  charged  with  an  abun- 
dance of  force  for  the  labors  of  the  day.  Sleepless  nights 
quickly  exhaust  the  reserve  force  and  a  time  comes  when 
the  individual  must  sleep.  A  young,  strong  person 
quickly  recuperates  from  the  effects  of  prolonged  loss  of 
sleep  because  his  vigorous  young  brain  and  nerve-cells 
have  the  power  of  rapidly  absorbing  new  force;  in  the 
old  or  enfeebled,  this  power  of  creating  nerve-force  is  slow, 
and  recuperation  correspondingly  so. 

CONSEQUENCES  OP  EXCESSIVE  NERVE-WASTE. — Thus 
the  nerve-cells  are  constantly  the  seat  of  two  processes — 
nerve-waste  and  nerve-repair.  When  these  two  processes 
are  proportionate  in  the  individual,  all  goes  well.  But 
when  nerve-waste  habitually,  or  for  a  time,  exceeds  repair 
certain  changes  take  place  within  the  nerve-cell;  it  be- 
comes weakened,  not  only  in  its  capacity  to  put  out  force, 
but  also  in  its  capacity  to  attract  nourishment  and  create 
force  from  the  blood;  it  becomes  irritable ',  over-sensitive 
to  impressions,  its  power  of  enduring  is  diminished. 
When  these  two  conditions  of  weakness  and  irritability 
become  established  in  the  nerve-cells,  other  parts  of  the 
body  suffer  ;  the  whole  physiology  of  the  individual  may 
become  disordered,  weakened,  unsteady.  Nervousness, 
nervous  debility,  nervous  prostration  or  exhaustion,  are 
names  in  common,  used  to  describe  the  consequences  of  a 
continued  predominance  of  nerve- waste  over  nerve-repair. 


II 

THE     CAUSES     OP     NERVOUS     IMPAIRMENT 

The  causes  of  nervous  impairment  are  of  two  kinds : 
those  which  originate  without,  and  those  which  are  de- 
veloped within  the  individual.  In  the  first  class  may  be 
placed  Environment  and  Heredity  ;  in  the  second  class  all 
those  countless  forms  of  nerve- waste  which  are  so  common 
in  modern  life,  and  which  may  be  pretty  completely  sum- 
med up  in  two  words,  Overwork  and  Dissipation. 

THE  EPOCH. — Modern  life  is  hard  upon  the  nervous 
system.  The  age  of  electricity,  of  complicated  machin- 
ery, of  intricate  business  methods,  is  upon  us.  '  *  The  rail- 
road brain  ' '  and  ' '  the  railroad  spine  ' '  are  beginning  to 
be  talked  of  in  medical  meetings.  The  roar,  the  jar,  the 
ceaseless  eye  and  ear  stimulation,  the  tyranny  of~"the 
clock,  and  the  increasing  sunlessness  of  cities  did  not  act 
upon  the  fathers.  The  endiess  memory-weakening  suc- 
cession of  ideas  in  newspaper  and  review  tittillates  rather 
than  exercises,  superficially  burnishes  rather  than  solidly 
strengthens  the  organ  of  mind.  The  factors  which  pro- 
duce nervousness  are  probably  more  numerous  and  ac- 
tive among  Americans  than  among  any  other  people — the 
^American  diathesis  is  becoming  more  and  more  distinctly 
jieryous.  The  possibilities  of  man  in  America  are  great 
and  they  excite  ambition — to  become  rich,  to  rise  in  the 
social  scale,  to  accomplish  objects  which  involve  struggle , 
sacrifice,  anxiety.  The  American  is  new,  unsettled,  unlo- 
cated,  in  a  state  of  insecurity  and  unrest,  which  is  unfavor- 
able to  health.  The  climate  of  much  of  the  United  States 

(6) 


THE    CAUSES   OF   NERVOUS    IMPAIRMENT.  7 

is  bracing,  and  permits  and  encourages  a  greater  amount 
of  nervous  expenditure  than  is  possible  in  any  other  part 
of  the  civilized  world.  The  American  is  not  yet  used  to 
his  environment;  many  a  man  overboard  has  sunk  in  strug- 
gling, who,  with  less  exertion,  could  have  kept  afloat. 

THE  NERVOUS  CONSTITUTION — In  the  nervous  temper- 
ament of  the  old  writers,  strength  and  endurance  of  the 
nervous  system  was  the  salient  feature.  By  reason  of 
this  very  strength  and  endurance  the  nervous  tempera- 
ment, in  the  stimulating  environment  of  modern  life,  is 
apt  to  undertake  too  much,  to  work  unceasingly  or  to 
dissipate  to  excess.  Thus  it  conies  about  that  the  nervous 
temperament  develops  an  irritable  and  weakened  con- 
dition of  the  nervous  system  instead  of  the  endurance 
which  was  one  of  its  original  characteristics.  "Neurotic' ' 
is  a  word  which  has  come  into  common  use  in  modern 
medical  literature  to  designate  this  state  of  more  or  less 
nervous  weakness,  and  susceptibility  to  some  form  of 
nervous  disorder. 

OVERWORK. — The  elements  of  overwork  which  involve 
excessive  nerve-waste  are  over- activity,  tension,  over- 
excitement  and  monotony. 

Full  exercise  of  the  brain  is  favorable  to  health  and 
longevity;  it  inhibits  the  emotions,  strengthens  the  will 
and  acts  as  a  moral,  mental  and  physical  tonic.  Kven 
prolonged  brain-work  is  not  necessarily  injurious  when 
unattended  by  hurry,  anxiety  or  excitement,  a  fact  which 
is  illustrated  in  the  biographies  of  innumerable  long-lived 
brain-workers,  and  mental  idleness,  plus  the  dissipation 
which  it  is  apt  to  engender,  is  one  common  cause  of  ner- 
vous impairment. 

An  incessant  mental  and  nervous  over-activity  seems  to 
be  inseparable  from  many  vocations.  Some  men  are 
habitually  stimulated  or  goaded  by  circumstances  into 
working  beyond  their  strength;  they  regularly  work  at 
high-pressure. 


8  NERVE    WASTE. 

The  exigencies  of  life  often  necessitate  spurts  of  work; 
the  lawyer  works  almost  night  and  day  for  weeks  on  an 
important  case;  the  inventor  pursues  some  promising  idea 
for  days,  neglecting  sleep  and  even  food.  In  many  com- 
mercial houses  there  are  periodically  recurring  busy  times, 
when  the  closure  of  the  doors  at  evening  does  not  end  the 
day's  toil,  the  wear  and  tear  goes  on  by  gaslight  till  late 
at  night  or  early  morning. 

The  young  and  the  strong  have  a  large  reserve  fund  of 
nerve-force  and  pass  through  these  periods  of  excessive 
work  without  permanent  injury.  But  the  individual 
whose  nervous  system  is  his  weak  part  is  subject  to  laws 
that  do  not  apply  to  others,  just  as  the  man  in  straightened 
pecuniary  circumstances  is  obliged  to  forego  expenditures 
rthat  are  scarcely  felt  by  his  well-to-do  neighbors.  The 
relation  of  over-activity  to  nervous  disease  is  as  simple  as 
suFtractionr  The  man  puts  out  more  than  he  takes  in, 
and  sooner  or  later,  according  to  the  extent  of_hjs  nerve- 
capital,  he  becomes  embarrassed,  crippled  or  fails j^njirely 
in  his  vital  power. 

Many  occupations,  for  example  type-setting,  sewing 
machine  running,  or  vocations  which  require  prolonged 
standing,  involve  an  over-activity  of  certain  muscles;  as 
a  result  a  worn  and  iritable  condition  of  that  portion  of 
the  spinal  cord  which  controls  the  nutrition  of,  and  sup- 
plies the  power  to  these  muscles  may  be  established. 

The  spinal  cord  is  a  highly  important  part  of  the 
nervous  system,  having  many  similarities  of  structure  and 
function  to  the  brain;  it  is  in  fact  a  continuation  of  the 
brain,  and  some  physiologists  look  upon  it  and  the  brain 
together  as  a  single  complex  organ.  When  local  irritation 
is  once  established  in  the  spine  it  may  irritate  and  depress 
the  whole  nervous  system  and  give  rise  to  many  distress- 
ing symptoms. 

The  tenison  of  anxiety  so  common  among  manu- 
facturers, merchants  and  men  holding  responsible 


THE  CAUSES  OP  NERVOUS  IMPAIRMENT.         9 

positions,  is  an  element  of  work  that  is  in  some  respects 
worse  than  mere  over- activity,  and  the  two  often  go 
together. 

If  a  long,  flexible  finely  tempered  sword  be  supported 
at  its  extremities  and  subjected  to  a  moderate  weight  at 
its  middle,  it  will  bend,  and,  as  often  as  the  weight  is 
lifted  from  it,  will  fly  back  to  its  natural  shape,  though 
this  act  be  repeated  a  million  times;  if  an  excessive 
weight  be  brought  to  bear  upon  the  steel  it  is  snapped  in 
twain;  if  the  blade  be  subjected  to  the  strain  of  a  lesser 
but  still  too  heavy  weight,  it  will  yet  respond  up  to  a 
certain  point  of  strain;  if  the  too  heavy  weight  is 
maintained  during  months  and  years,  the  resiliency  and 
elasticity  of  the  blade  is  impaired,  the  sword  becomes 
crooked,  inelastic,  lifeless.  So  it  is  with  human  vitality; 
a  man  may  sustain  heavy  day  strain  throughout  a  long 
life,  if  the  succeeding  night  hours  are  periods  of  true 
relaxation;  it  is  the  carrying  of  business  cares  and 
worriments  over  night  that  impairs  the  fibre  of  the  delicate 
and  high-strung  nervous  organization  of  the  nervous 
constitution. 

With  certain  workers,  as  locomotive  engineers,  bank 
tellers,  dentists,  the  largest  experience  and  the  most 
practised  skill  can  never  dispense  with  an  abnormal  vigi- 
lance, an  over-alertness,  which  kept  up  day  after  day, 
and  year  after  year,  is  wearing  in  the  extreme,  and  which 
not  unfrequently  proves  a  strain  that  breaks. 

Over-excitement  is  excessively  rapid  nerve-waste;  it  is 
tying  down  the  safety  valve  and  burning  lard  in  the  fur- 
nace. A  measure  of  excitement  is  good  for  the  brain  and 
nerves,  it  stirs  up  the  nutritive  processes,  cleans  out  the 
cobwebs,  and  leaves  the  mind  clearer  and  stronger  for  it. 
But  excessive  excitement  has  burned  the  youth  out  of 
many  a  brain  and  left  its  possessor  an  old  man  at  forty. 
The  stock-boat d  and  the  street  are  notorious  fields  of 
shattered  nerves  and  softened  brains,  and  every  year  the 


IO  NERVE    WASTE. 

excitement  of  political  campaigns  makes  overdrafts  upon 
the  vitality  of  thousands. 

There  are  men  whose  work  involves  no  great  over- 
activity  nor  anxiety  nor  excitement,  and  yet  they  suffer 
from  the  monotonous  repetition  of  one  set  of  acts  and  im- 
pressions. The  whole  brain  is  not  uniformly  exercised  by 
any  act  nor  set  of  acts,  but  only  certain  parts  of  it.  So 
certain  impressions,  as  sights  and  sounds,  do  not  impress 
the  whole  brain,  but  only  small  areas  of  it  whose  function 
it  is  to  receive  and  take  cognizance  of  this  class  of  impres- 
sions. By  a  constant  harping  on  one  string  it  wears  out 
before  the  others.  By  a  continuous  exercise  of  one  set  of 
brain-cells  to  the  comparative  exclusion  of  others,  they 
become  tired,  then  exhausted  and  incapable  of  further  con- 
tinuance in  this  particular  groove  without  suffering  to  the 
individual,  Thus  the  book-keeper,  dealing  with  figures 
and  nothing  but  figures  year  after  year,  becomes  tired, 
listless,  inelastic  and  finally  incapable  of  work.  A  vaca- 
tion trip  to  the  seaside  or  the  mountains  benefits  him 
immensely,  partly  by  the  power  of  pure  air  and  exercise, 
but  largely  because  the  overworked  areas  of  the  brain  are 
rested,  and  because  a  new  set  of  acts  and  impressions  ex- 
ercises other  brain-cells  that  needed  exercising. 

The  physiological  history  of  every  man  is  that  he  grad- 
ually matures,  then  for  a  few  years  is  at  the  maximum  of 
his  strength,  then  gradually  fails  to  old  age.  The  time 
when  a  man  is  at  his  best,  is  limited  to  a  few  years — 
champion  athletes  seldom  maintain  their  supremacy  ten 
years.  Such  men  may  appear  to  be  as  strong  or  stronger 
than  ever  before,  but  the  invisible  fountains  of  power,  deep 
in  the  nervous  structures,  have  begun  their  retrograde 
change,  their  day  is  passed,  and  in  the  race  some  fresher 
man  wins  the  prize.  The  amount  of  work  which  a  man 
can  easily  do  between  thirty  and  forty  should  not  be  his 
standard  of  achievement  in  later  years;  when  he  has  started 
to  descend  the  hill  of  life,  his  work  should  become  easier 


THE    CAUSES    OF    NERVOUS    IMPAIRMENT.  II 

and  his  holidays  and  vacations  should  become  more  and 
more  frequent.  Unfortunately  this  is  not  often  possible; 
sometimes  an  acquired  inability  to  enjoy  anything  else  in 
life  but  work  is  one  of  the  bitter  elements  in  the  cup  of 
success,  but  more  often  stern  duty  to  others,  and  the  grind- 
ing competition  of  young  and  tireless  rivals  keep  the  older 
man  to  a  pace  beyond  his  failing  strength.  At  this  stage 
of  our  national  development  overwork  seems  to  be  an 
inevitable  condition  of  existence,  but  it  is  to  be  hoped 
that  increasing  prosperity  and  increasing  wisdom  will 
reduce  the  exactions  and  lessen  the  often  terrible  price 
which  men  pay  for  decent  success,  and  that  the  "gospel 
of  relaxation,"  preached  by  Herbert  Spencer,  may  become 
fashionable  in  the  land. 

SOCIAL  NERVE-WASTE. — Nervous  men  and  women  are 
apt  to  be  fond  of  amusements,  and  of  the  excitements  of 
social  life;  these  seem  like  recreation  after  a  day  of  toil, 
and,  in  some  degree,  they  are  such.  But  when  they  are 
carried  to  excess,  or  when  they  involve  undue  excitement, 
or  encroach  upon  the  hours  of  sleep,  in  a  person  whose 
nervous  system  is  weakened,  they  draw  steadily  upon  the 
diminished  fund  of  vitality.  There  are  many  forms  of 
social  duty,  as  those  incident  to  church,  lodge  and  politics 
which  require  night  work  without  being  in  any  degree 
recreative,  and  which  become  auxilliary  causes  of  nervous 
impairment. 

WORRY. — There  are  minds  that  no  trouble  can  injure — 
it  glides  off  as  water  does  from  a  duck's  back ;  it  does  not 
sink  in  and  corrode  ;  but  nervous  people  are  seldom  phil- 
osophical or  phlegmatic  enough  for  this.  Domestic  trou- 
ble often  aggravates  nervous  weakness,  and  instances 
where  the  thinning  and  rapidly  ageing  face  are  the  only 
signs  of  silently  borne  grief  are  within  the  range  of  every- 
one's experience  ;  the  skeleton  in  the  closet  is  oftener  re- 
vealed to  the  physician  than  to  any  other,  and  his  skill  to 
heal  often  stand  helpless  before  its  power  to  wreck. 


12  NERVE    WASTE. 

Success  or  failure  in  life,  whether  accident  or  sequence, 
has  much  to  do  with  the  health  of  the  individual.  Suc- 
cess brings  friends,  favors  and  pleasant  words,  a  thousand 
little  amenities  that  smooth  the  road  of  life.  The  con- 
sciousness of  being  somebody,  of  cutting  a  good  figure  in 
the  world,  is  exalting  and  sustaining  ;  it  buoys  and  enables 
many  a  weak  man  to  accomplish  a  long  life  journey  that  he 
never  could  have  accomplished  had  the  way  been  rougher. 
Failure  depresses  and  irritates  ;  the  sensitive  mind  of  the 
man  who  has  failed  poorly  withstands  the  rebuffs,  the 
harsh  words,  the  neglect  or  the  scarcely  concealed  con- 
tempt of  his  fellows.  The  depressing  influence  of  disap- 
pointed ambitions  and  a  hopeless  future  is  sometimes  a 
powerful  obstacle  to  recovery. 

SCHOOL-LIFE — Anyone  who  is  often  abroad  at  the  hours 
when  the  children  are  going  to  and  from  school,  must  have 
noticed  that  a  certain  proportion  of  them  are  very  thin, 
pallid,  and  as  far  as  possible  from  the  normal  standard  of 
plump,  rosy,  healthful  childhood.  During  the  past  twenty 
years  there  has  been  no  lack  of  protest  against  what  Hux- 
ley vigorously  designated  "precocious  mental  debauchery" 
and  '  'book  gluttony  and  lesson  bibbing, ' '  but  it  would  seem 
that  the  teacher  and  the  parent  can  not  often  be  made  to 
see  this  subject  from  the  point  of  view  of  the  physiologist. 

Over-pressure  and  over-application  are  relative  terms  • 
what  is  overwork  for  one  child  may  be  easy  work  for 
another.  From  the  standpoint  of  the  physician,  the 
routine  method  of  teaching  which  goads  every  one  of  fifty 
children,  of  widely  varying  physical  and  mental  strength, 
to  a  high  standard  of  accomplishment,  under  penalty  of  a 
certain  disgrace  at  school  and  at  home,  is  pernicious  in 
the  extreme. 

The  idea  that  exercise  strengthens  the  brain  and  mind 
is  true  up  to  the  boundary  line  in  the  individual  where 
exercise  becomes  overwork.  The  long  lessons,  the 
struggle  to  keep  up,  the  cramming  for  examinations,  all 


THE    CAUSES   OF   NERVOUS   IMPAIRMENT.  13 

mean  the  expenditure  of  brain-force.  This  force  must  come 
from  somewhere ;  the  brain  draws  upon  the  blood-current 
to  a  greater  extent  than  the  physiological  economy  of  the 
child  provides  for ;  the  result  is  that  certain  chemical 
elements  of  the  blood,  which  ought  to  be,  and  naturally 
would  be,  converted  into  bone,  muscle  and  nerve  tissue, 
are  diverted  from  this  course,  by  the  demands  of  the  brain  ; 
the  bones  and  muscles  are  poorly  nourished,  and  the 
child  is  stunted  in  growth  and  never  becomes  the  man, 
physical  or  mental,  that  he  might  have  become.  This  is 
the  story  of  the  undeveloped  muscles,  the  short  stature, 
the  physical  insignificance  of  thousands,  whose  parents 
before  them  were  large  and  handsome  specimens  of 
humanity. 

Many  intelligent  educators  recognize  these  facts,  but 
the  teacher  is  no  more  able  than  other  men,  to  work  a 
revolution  within  the  sphere  of  his  duty ;  the  unwise 
ambition  of  parents  is  as  often  responsible  as  the  zeal  of 
the  teacher  for  the  nervous  disorders  arising  out  of  school- 
life.  The  father  who  has  begotten  a  nervous  child  owes 
it  to  that  child  to  exercise  more  than  ordinary  care  in  its 
education  ;  school  honors  and  study  must  be  subordinated 
to  physical  development,  which  includes  the  physical 
brain  and  nerve  tissues  as  well  as  bone  and  muscle  tissues. 

If  such  a  child  cannot  keep  up  with  other  children  who 
have  inherited  strong  nervous  systems,  without  abnormal 
thinness,  headaches,  "  nervousness, "  then  let  him  stay 
behind.  The  parent  should  never  encourage  such  a  child, 
by  rewards  or  by  reproaches,  to  become  first  in  his  class. 
Many  nervous  children  are  extremely  bright;  they  learn 
quickly  and  with  an  apparent  ease  which  gains  them 
praises  and  honors,  and  leads  the  parents  to  expect  and 
to  exact  great  things;  unfortunately,  experience  shows 
that  this  mental  precocity  is  not  often  maintained  in  after 
life. 


14  NERVE    WASTE. 

Instead  of  ( '  The  mind  is  the  measure  of  the  man, ' '  it 
might  be  said  in  these  days  that  nerve-force  is  the  measure 
of  the  man,  so  important  a  part  does  this  quality  play  in 
the  battles  of  life.  The  man  who  at  thirty  finds  himself 
with  a  strong  nervous  system  has  in  it  a  possession  of 
appreciable  coin  value.  Modern  life  demands  not  only 
fine  work  but  a  quantity  of  it,  and  many  a  fine  worker 
has  been  obliged  to  abandon  a  lucrative  position  to  some 
one  less  skillful,  for  lack  of  the  necessary  staying  powers. 

SEDENTARY  HABITS. — A  principle  of  physiology  is  that 
"a  functional  act  is  a  nutritive  act;"  in  other  words,  an 
organ  is  nourished,  within  certain  limits,  in  proportion 
as  it  is  used.  An  organ  to  be  healthy  must  be  used,  but  not 
over-used.  Sedentary  man  over- uses  one  organ — the  brain- 
and-spine  and  under-uses  all  the  others.  This  dispropor- 
tionate activity  or  strain  upon  the  organ  of  vitality  is  one 
effect  of  sedentary  habits.  The  overworked  city  man  be- 
comes indolent  and  luxurious  in  his  hour  of  ease.  He  rides 
rather  than  walks,  he  seeks  to  habitually  breathe  a  warmed 
air,  chews  succulent  food,  wears  hard  hats,  glazed  shirt- 
fronts  and  garments  which  fulfil  his  idea  of  elegance  and 
dignity  of  appearance  rather  than  permit  grace  and  sup- 
pleness. Suppleness  scarcely  exists  among  us,  and  if  an 
Olympian  athlete  could  see  a  hundred  average  Americans 
in  running  costume,  it  is  to  be  feared  that  their  partially 
bald  heads,  filled  teeth,  flat  chests,  thin  limbs,  stiff  joints, 
and  deformed  feet,  would  excite  his  derision  or  his  pity. 

LUXURY  e-nervates  as  effectually  as  overwork  and 
strain.  That  combination  of  indolence,  self-indulgence, 
over-eating,  jinder-breathing  and  nervous  excitement, 
which  may  be  observed  in  certain  sons  and  daughters  of 
wealth,  leads  to  nervous  impairment^  An  under-used 
brain-and-spine  comes  to  be  poorly  nourished,  to  have  a 
flabby  fibre,  and  to  seek  stimulants  to  c  'pull  itself  together. ' ' 
A  brain-and-spine  whose  activity  takes  the  form  of  excite- 
ment rather  than  of  work,  becomes  irritable  and  craves 


THE  CAUSES  OF  NERVOUS  IMPAIRMENT.        15 

the  soothing  influence  of  narcotics.  No  observation  of 
medical  practice  is  more  constant  or  more  striking  than 
that  those  who  persistently  seek  comfort  and  pleasure 
are  the  very  ones  who  find  annoyance  and  pain.  L,ike  the 
princess  in  the  fairy  tale  whose  tender  flesh  was  irritated 
by  a  crumpled  rose-leaf  under  twenty  mattresses,  self- 
indulgence  acquires  sources  of  suffering  of  which  hardier 
mortals  are  ignorant. 

The  clergyman  can  teach  more  eloquently  than  the  phy- 
sician how  excess  of  comfort  makes  us  selfish  ;  how  men 
who  have  never  striven ,  and  women  who  have  never  suffer- 
ed, have  lacked  the  most  potent  force  in  human  character  ; 
how  luxury  and  moral  hebetude  go  hand  in  hand,  and  how 
those  who  have  been  given  every  opportunity  for  symmet- 
rical growth  and  instructive  example,  are  commissioned, 
and  ignobly,  if  at  all,  neglect  their  chances  in  the  circean 
isle.  But  the  physician,  with  his  records  of  cases,  and  his 
offensive  specimens  gathered  from  the  dead-house  can  more 
forcibly,  if  rudely,  demonstrate  how  sloth  and  sensuality 
lead  to  decay  and  death. 


Ill 

CAUSES  OF  NERVOUS  IMPAIRMENT  (Continued) 

OCULAR  DEFECTS,  near-sight,  and  far-sight  —  causing 
imperfect  perception,  and  astigmatism  (corneal  asymme- 
try)— causing  faulty  refraction,  are  common  unsuspect- 
ed exciting  or  aggravating  causes  of  nervous  symptoms  in 
school  children,  students  and  others.  No  phase  of  nervous 
disorder  is  more  pathetic  than  that  in  which  a  child  is  held 
to  its  work,  spite  of  headache,  eye- tire,  incompetency  and 
strange  feelings  which  it  cannot  itself  describe  and  which 
are  not  understood  by  others. 

Dr.  H.  P.  Allen  of  Columbus,  O.,  was  recently  appointed 
by  the  Board  of  Education  to  examine  the  eyes  of  the 
children  in  the  public  schools  of  that  city.  His  report 
states  that  of  4, 700  children  examined  i ,  1 75  were  found 
to  have  defective  vision  in  one  or  both  eyes.  Near-sight- 
edness increased  from  none  at  all  in  the  primary  schools 
to  13  per  cent  in  boys,  and  17  per  cent  in  girls  in  the  senior 
class  of  the  high  school ;  according  to  age  it  increased  from 
none  at  six  years  to  i  iTsff  per  cent  at  17  years.  Of  all  chil- 
dren who  needed  correcting  glasses,  only  about  10  per  cent 
had  them.  In  the  Polytechnic  school  of  France,  the  pro- 
portion of  myopia  has  increased  from  30  to  50  per  cent, 
and  80  per  cent  of  all  the  students  have  to  wear  glasses. 

In  view  of  the  wide-spread  and  great  increase  of  myopia 
in  all  civilized  countries,  it  becomes  the  duty  of  parents 
to  give  their  children's  eyes  the  same  watchful  care  that 
they  now  do  their  teeth.  Dr.  Dennett  of  New  York  has 
made  the  excellent  suggestion  that  a  test-type  placard  be 
hung  in  every  class-room  in  the  land;  the  card  which  he 
proposes  is  simple,  consisting  of  a  series  of  letters  and 

(16) 


CAUSES  OF  NERVOUS  IMPAIRMENT.         17 

characters  with  directions  concerning  the  distance  at  which 
each  size  should  be  read  by  the  normal  eye. 

The  muscles  of  the  orbit  which  control  the  movements 
of  the  eye-ball  may  become  weakened,  asthenic,  and  the 
disagreement  between  these  and  the  internal  accommo- 
dating muscles  of  the  eye  maintains  a  constant  eye-strain. 
These  eye-strains  are  very  wearing  upon  the  brain,  and 
are  capable  of  causing  a  high  degree  of  nervous  impair- 
ment, persistent  headaches,  and  even  epilepsy.  Some  re- 
markable results  in  the  cure  or  alleviation  of  epilepsy,  by 
the  operator  of  ocular  tenotomy,  thus  removing  hurtful 
eye  tension,  have  lately  been  obtained. 

The  manner  in  which  eye-muscle  weakness  and  eye-ball 
defect  harass  and  injure  the  brain  may  be  thus  stated. 
When  a  visual  impression  strikes  the  eye-ball,  it  is  refracted 
through  the  various  media  within  and  focused  upon  the 
sensitive  membrane  (the  retina)  which  lines  its  posterior 
wall.  Thence  it  is  transmitted  along  the  optic  nerve  to 
the  great  central  receptive  ganglion  of  the  brain  (the 
central  home-office  for  sensation)  the  optic  thalamus,  which 
lies  near  the  bottom  of  me  brain.  Thence  it  is  radiated 
to,  and  received  by  those  brain-cells  in  the  surface  of  the 
brain  which  are  concerned  in  the  particular  impression. 
(This  outer  gra}'  substance  of  the  brain — the  cortex,  or 
peeling,  bears  a  similar  quantitative  relation  to  the  rest  of 
the  brain  that  a  three-quarter  section  of  a  peach  does  to  its 
stone.)  With  a  normal  visual  apparatus  a  clear  impression 
is  received  at  the  central  home-office  and  distributed  to  the 
out-lying  brain-cells  with  facility.  With  a  faulty  appara- 
tus, the  image  formed  upon  the  optic  thalamus  is  not 
distinct;  it  is  blurred;  the  higher  brain-cells  recognize  it 
with  an  effort,  and  here  lies  the  strain.  What  should  be 
an  automatic  act  is  converted  into  a  voluntary  one.  So,  in 
our  great  post-offices  the  immense  effort  and  strain  of  re- 
ceiving and  distributing  letters  is  largely  due  to  the  fact 
that  so  many  of  them  are  illegibly  addressed. 


1 8  NERVE    WASTE. 

Ear-strains  may  cause  or  aggravate  nerve-weakness  in 
the  same  way  that  eye-strains  do.  A  plug  of  wax  in  the 
external  ear,  a  chronic  inflammatory  condition  of  the  mid- 
dle ear,  and  other  conditions  may  impair  hearing  and  cause 
an  indistinct  auditory  impression  to  be  received  at  the 
optic  thalamus,  the  recognition  of  which  puts  a  strain 
upon  the  brain. 

REPRODUCTIVE  MISFORTUNES  AND  MALPRACTICES  are 
active  and  powerful  causes  of  nervous  impairment.  Ex- 
cessive child-bearing  or  prolonged  nursing,  combined 
with  household  drudgery,  reduces  many  a  mother  to  a 
serious  condition  of  nerve-weakness.  On  the  other  hand, 
those  parents  who  refuse  to  accept  the  trials  of  parentage 
are  often  injured  by  such  a  course.  All  those  ingenious 
perversions  of  the  natural  physiological  relations  of  mar- 
riage, aimed  at  the  prevention  of  conception,  which, 
judging  from  my  observations,  are  by  no  means  rare, 
prove  a  dangerous  strain,  and  make  serious  overdraft  upon 
the  vitality  of  thousands.  Worse  still,  the  practice  of 
criminal  abortion,  or  induced  "miscarriage,"  when  it 
does  not  cause  death,  may  bleed  out  a  woman's  vitality 
beyond  the  power  of  nature  to  restore  it,  or  it  may  leave 
scars  and  disease  in  the  delicate  reproductive  tissues, 
which,  acting  backwards,  persistently  harass  and  weaken 
the  nervous  system. 

Sexual  abuse  and  excess  are  to  be  expected  in  our 
American  life.  We  have  noted  that  the  American,  by 
reason  of  his  constitution,  his  climate,  the  transition 
period  in  which  he  lives,  is  essentially  nervous,  his  brain- 
and-spine  over-active,  over-sensitive,  unstable,  loving  ex- 
citement, craving  new  things.  Especially  the  city  boy 
and  man,  under-using  all  extra-neural  tissues  and  over- 
using the  brain-and-spine,  deteriorates  in  hair,  teeth, 
muscle,  skeleton,  and  develops  a  morbid  sensibility  in 
nerve-tissue  everywhere.  'This  state  of  nervous  erythism 
craves  all  sorts  of  morbid  excitementTand  quickly  responds 


CAUSES  OF  NERVOUS  IMPAIRMENT.  19 

to  erotic  suggestion,  and  becomes  the  victim  of  sexual 
vice^  Sexual  vice  has  operated  against  health  since  the 
beginning  of  history,  but  probably  it  has  never  been  so 
injurious  to  vitality  as  it  is  in  the  nineteenth  century 
American.  I  am  constantly  obliged  to  note  how  the 
neurotic  diathesis',  sedentary  habits,  erotic  suggestion  and 
igSonmceTb'f  fiienaws~or^exjial^hy^ien^^ct  together  to 
produce  mental  and  nervous  disease. 

REFLEX  IRRITATION. — The  central  nervous  system, 
within  its  bony  case  of  skull  and  spine,  communicates 
with  every  other  part  of  the  body  by  means  of  nerves. 
These  nerves  constantly  conduct  nervous  impulses  from 
the  brain- and-spine  to  other  parts  of  the  body,  and  con- 
stantly transmit  nervous  sensations  from  every  other  part 
of  the  body,  generally  through  the  spine  to  the  brain. 
An  impression  made  upon  one  part  of  the  body  may 
influence  some  distant  part  by  influencing  nerve-centers 
which  are  common  to  both.  Thus,  a  hot  application  to 
the  abdomen  relieves  intestinal  colic,  not  by  ' '  striking  in, ' ' 
but  by  producing  a  relaxing  influence  upon  the  bowel 
through  the  spine  and  sympathetic.  Slight,  persistent 
morbid  impressions  are  capable,  by  their  cumulative  action, 
of  producing  very  serious  diseases.  Thus,  the  back-acting 
irritations  of  teething,  of  indigestible  food  and  of  worms 
are  frequent  causes  of  convulsions  in  infants.  The  irri- 
tating impression  of  a  tight  foreskin  has  often  caused  con- 
vulsions or  paralysis  in  children.  The  irritating  presence 
of  dried  secretions  in  the  nose  or  throat,  reflected  upon 
an  over-sensitive  nervous  system,  is  a  common  cause  of 
asthma,  hay-fever  and  deafness. 

The  principle  of  reflex  action  is  the  basis  of  a  certain 
proportion  of  cases  of  nervous  impairment  which  might 
be  described  as  back-acting,  reflex,  afferent  or  inverse 
neurasthenia.  In  this  form  the  nerve-weakness  is  second- 
ary to  local  disease  in  some  other  part  of  the  body.  A 
long  series  of  irritating  morbid  impressions  reacting  upon 


2O  NERVE    WASTE. 

brain-and-spine,  harass,  irritate,  depress  these  parts,  and 
ultimately  impair  their  nutrition  and  lessen  their  capacity 
for  creating  and  supplying  vital  force. 

Nasal  catarrh  may  be  instanced  as  a  purely  local  dis- 
ease which  often  develops  a  high  degree  of  secondary 
mental  and  nervous  disorder.  ' '  Spinal  irritation  ' '  is  often 
maintained  by  disorder  of  womb  or  rectum.  Kpilepsy, 
St.  Vitus'  dance,  lock-jaw  and  every  form  of  persistent 
convulsive  disorder  may  result  from  such  apparently 
inadequate  irritations  as  eye  or  ear  strains,  from  hardened 
wax  in  the  ear,  or  from  chronic  constipation.  The  first 
thing  an  expert  in  nervous  diseases  does  with  a  new  case 
of  "fits,"  of  which  the  cause  is  not  obvious,  is  to  over- 
haul the  patient  from  head  to  heel  in  the  search  for  possi- 
ble sources  of  reflex  irritation.  The  mental  symptoms  of 
chronic  dyspepsia  may  be  studied  in  almost  any  house- 
hold. Diseases  of  the  womb  and  ovaries  in  the  female, 
diseases  of  the  male  reproductive  organs,  and  rectal 
diseases,  all  develop  a  long  train  of  mental  and  nervous 
symptoms  in  certain  cases. 

In  many  cases  of  chronic  local  disease,  the  secondary 
impairment  of  the  brain-and-spine  comes  to  be  by  far  the 
most  important  element.  As  between  two  crippled  organs, 
the  nose  or  the  rectum,  on  the  one  hand,  and  the  brain- 
and-spine  on  the  other,  the  latter  is  certainly  by  far  the 
most  important,  even  though  the  former  is  the  primary 
disease.  Thus,  the  physician  who  fixes  his  attention  nar- 
rowly upon  a  disease-process  in  eye,  ear,  nose,  stomach, 
womb,  prostate,  or  rectum,  and  ignores  the  secondary 
brain-and-spine  complications,  greatly  limits  his  use/ul- 
ness.  This  is  a  danger  to  which  the  specialist,  who 
comes  to  his  work  without  broad  training,  is  liable.  In  a 
purely  local  interest  in  the  physical  or  mechanical  problems 
of  a  case,  it  is  possible  to  neglect  the  often  graver  second- 
ary mental  and  nervous  symptoms;  one  may  forget  the 
patient  in  studying  the  disease. 


IV 

TYPES    OF    NERVOUS    IMPAIRMENT 

THE  NEUROTIC  DIATHESIS. — A  diathesis  is  an  inher- 
ited morbid  tendency;  thus  we  notice  the  gouty,  the 
scrofulous  and  the  tuberculous  diatheses.  The  neurotic 
diathesis  is  the  foundation  of  a  large  proportion  of  cases 
of  nervous  impairment.  It  becomes  established  in  ner- 
vous stocks  as  a  result  of  the  nervous  strain  and  over- 
draft of  civilized  life  ;  city  Americans  of  the  second  and 
third  generation  are  apt  to  be  more  or  less  neurotic. 

Persons  of  this  diathesis  live  and  work  with  a  very 
small  reserve  fund  of  nerve-force.  They  are  like  a  mer- 
chant doing  business  upon  limited  capital;  every  little 
loss  and  waste  embarrasses  them  and  a  large  one  threatens 
to  bankrupt  them  completely.  They  are  always  trying 
to  keep  even.  On  those  days  in  which  they  live  within 
their  nervous  income  they  may  be  pretty  well,  but  when 
they  exceed  it  they  suffer  to  some  extent ;  a  slight 
indiscretion  may  precipitate  very  disagreeable  symptoms. 
A  man  in  a  strange  land  with  a  hundred  dollars  in  his 
purse  may  be  very  happy  in  expending  ninety-nine  dol- 
lars and  very  miserable  in  expending  one  hundred  and 
one.  Such  men  and  women  may  be  ' '  all  broken  up, ' '  as 
they  say,  by  an  indigestible  supper,  a  bad  night's  sleep, 
a  piece  of  bad  news,  a  seminal  loss,  or  a  few  days  of  over- 
work. They  envy  persons  of  great  vital  resources,  whose 
large  reserve  fund  of  nerve-force  enables  them  to  expend 
in  every  direction  with  impunity,  and  which  seems  to 
exempt  them  for  a  time  from  obedience  to  the  laws  of 
health. 

The  nervous  diathesis  is  not  always  a  misfortune  ;  in 
many  cases  it  is  a  blessing  in  disguise.  The  nervously 

(21) 


22  NERVE    WASTE. 

poor  come  early  to  understand  the  science  of  vital  econ- 
omy and  to  be  obedient  subjects  of  the  goddess  Hygeia, 
and  so  are  rewarded  by  fairly  long  life.  The  fact  of 
limited  vital-surplus  keeps  many  a  man  in  the  straight 
and  narrow  path  of  virtue  who  would  otherwise  stray. 
Neurotic  men  are  apt  to  beget  bright,  beautiful  and 
interesting  children  and  to  make  the  best  parents.  Much 
of  the  world's  work  is  being  done  to-day  by  men  who  are 
more  or  less  crippled  in  their  vital  resources.  Altogether 
I  believe  that  neurotic  persons  who  are  not  too  unfortu- 
nate, or  too  reckless,  perceive  more,  feel  more,  accomplish 
more,  enjoy  more  and  get  more  out  of  life  than  those  of 
any  other  diathesis. 

NERVOUSNESS  is  only  the  manifestation  of  a  greater  or 
less  degree  of  nerve-weakness,  inherited  or  acquired. 

In  some  persons  any  emotional  perturbance  or  excite- 
ment, or  any  mental  effort  which  rapidly  uses  up  a  large 
amount  of  force,  leaves  the  whole  muscular  system  weak 
and  trembling,  and  periods  of  activity  and  vivacity  are 
apt  to  be  followed  by  periods  of  depression  and  wretched- 
ness ;  these  phenomena  indicate  the  smallness  of  the 
nervous  resources,  and  the  inconstant,  unstable  out-flow 
of  nerve-force.  So  the  intolerable  annoyance  which  some 
persons  feel  at  certain  creaking  noises,  the  sudden  starting 
at  slight,  unexpected  sounds,  the  excessive  peevishness, 
the  lack  of  self-control,  the  losing  presence  of  mind  at 
nothing  —  "going  all  to  pieces"  —  are  signs  of  the  abnor- 
mal susceptibility  and  lessened  endurance  of  the  nervous 
tissues. 


PROSTRATIONS  is  an  abrupt  failure  of  the  life- 
forces  ;  it  may  be  partially  recovered  from  in  a  few  days, 
or  it  may  keep  the  patient  hovering  between  life  and 
death  for  weeks,  according  to  the  degree  of  the  vital  over- 
draft. 

A  serious  case  of  nervous  prostration  is  as  impressive  a 
health  lesson  as  can  be  imagined.     The  active  man  of  a 


TYPES    OF    NERVOUS    IMPAIRMENT.  23 

few  days  before  is  now  a  helpless  inert  mass  ;  in  his  face 
every  vestige  of  youth,  health,  and  mental  power  is 
replaced  by  a  worn,  prematurely  aged  appearance  painful 
to  look  upon.  The  strong,  quick  intelligence  familiar  to 
his  friends  is  degraded  to  a  stupid  indifference,  or  inco- 
herence ;  in  some  cases  visions  or  delirium  occur  ;  the 
pulse  beats  quickly  and  feebly,  thin  as  a  thread  under  the 
finger,  and  almost  feels  as  though  it  might  at  any  moment 
die  away  forever.  Muscular  strength  is  at  its  lowest  ebb  ; 
slight  exertion  causes  trembling  ;  the  subject  is  unable  to 
rise  ;  he  is  forced  by  outraged  nature  to  permit  a  remedy 
that  was  long  ago  her  due  —  rest.  Fever,  persistent  sleep- 
lessness, headache,  vertigo,  congestion  of  the  brain, 
alarming  sinking  sensations  are  common  symptoms. 

In  some  cases  the  sick  man  never  reacts  from  this  col- 
lapse, but  after  lingering  for  days  or  weeks,  dies  —  a  real 
suicide  ;  but  the  larger  proportion  of  cases  slowly  respond 
to  rest,  judicious  medication  and  feeding.  A  careful 
nursing  of  the  remnants  of  life  recalls  the  subject  from 
his  graveward  course  ;  although,  after  passing  through 
such  an  experience,  the  patient  is  seldom  or  never  again 
the  man  he  was. 

J  -The     symptoms     of     uncomplicated 


nerve-weakness  have  been  long  familiar  to  physicians, 
but  it  is  only  in  late  years  that  their  full  import  has 
come  to  be  well  understood.  The  comprehensive  mental 
vision  of  Dr.  George  F.  Beard  collected  the  straggling 
objective  and  subjective  signs  of  nervous  impairment, 
classified  them,  appraised  them,  and  practically  created 
them  into  a  new  disease,  which  he  called  Neurasthenia  —  • 
literally,  nerve-  weakness.  The  scientific  propriety  of 
recognizing  neurasthenia  as  a  distinct  disease  has  been 
denied,  but  in  practice  there  is  no  other  disorder,  whose 
history  is  more  clear  and  symmetrical,  and  none  whose 
treatment  is  more  clearly  indicated.  The  neurasthenic  is 
a  nervous  cripple.  If  the  history  of  this  disorder  were 


24  NERVE    WASTE. 

required  to  be  written  in   three   words,  these   would  be 
weakness,  irritability,  unsteadiness. 
(CEREBRAL  NEURASTHENIA^  Cerebrasthenia,  Brain  Kx- 
Brain  Fag,  is  most  often  seen  in  men  be- 


tween the  ages  of  thirty  and  sixty,  whose  duties  and 
responsibilities  are  greater  than  they  can  bear  and  the 
strain  of  whose  work  falls  chiefly  or  wholly  upon  the 
brain.  Politicians,  manufacturers,  professional  men  and 
merchants  contribute  yearly  a  certain  number  to  the  list 
of  those  who  are  killed  or  crippled  by  this  form  of  neur- 
asthenia. Mental  symptoms  —  of  irritability  or  weak- 
ness —  are  generally  marked  in  these  cases.  The  sleepless- 
ness and  circulation  derangements  of  acute  brain  exhaus- 
tion are  capable  of  developing  insanity  . 

SPINAL  NEURASTHENIA  is  the  type  most  likely  to  be 
developed  when  strain  has  been  brought  to  bear  upon  the 
spinal  cord  more  than  upon  the  brain.  Telegraphers, 
compositors,  type-  writers,  penmen,  railroad  men  and 
house-wives  may  be  instanced  among  those  liable  to  this 
form  of  nerve-  weakness.  There  is  no  clear-cut  difference 
between  cere  oral  and  spinal  neurasthenia  ;  their  symptoms 
are  much  the  same,  but  are  apt  to  present  certain  differ- 
ences in  degree. 

SEXUAL  NEURASTHENIA  is  a  term  used  to  describe 
those  cases  in  which  nerve-weakness  is  partially  or  entirely 
manifested,  and,  in  many  cases,  originated,  in  the  repro- 
ductive apparatus.  This  class  of  cases  has  been  variously 
designatea  by  the  names  Spermatorrhoea,  Seminal  Weak- 
ness, Irritable  Prostate,  Impotency,  Sexual  Hypochon- 
driasis,  according  as  different  physicians  fixed  their  atten- 
tion upon  one  or  another  of  the  symptoms  which  char- 
acterize it. 

NERVE-WEAKNESS  MANIFESTED  BY  OTHER  ORGANS 
THAN  THE  BRAIN  AND  SPINE.  —  A  common  phase  of  city 
life  is  a  large  family  whose  only  resource  is  a  moderate 
salary  earned  by  the  father.  The  daughters  approaching 


TYPES   OF   NERVOUS    IMPAIRMENT.  25 

womanhood,  the  sons  at  college,  or  a  sick  child  have  the 
most  pressing  needs  and  absorb  an  undue  share  of  the 
slender  income.  There  is  not  enough  to  go  round,  and 
some  one,  too  often  the  mother,  must  manifest  poverty  for 
the  whole  family.  So  it  often  is  with  the  central  nervous 
system — the  great  vital  source — and  the  other  organs  and 
tissues  of  the  body,  which,  as  we  have  seen,  are  dependent 
upon  it  for  vitality.  Many  men  and  women  have  some 
organ  or  tissue  that  is,  by  inheritance  or  by  acquisition, 
weaker  than  the  others — it  is  their  vulnerable  point. 
When  excessive  brain  or  muscle  work  or  strain  uses  up  a 
disproportionate  amount  of  the  available  nerve-force  the 
supply  is  not  enough  to  go  round,  and  the  weak  part  is 
very  apt  to  suffer.  When  the  brain  and  spinal  impoverish- 
ment is  manifested  principally  in  the  digestive  apparatus 
we  have  the  type  gastric  neurasthenia,  to  the  various 
symptoms  of  which  the  names  oxaluria,  lithaemia,  lithiasis, 
liver  insufficiency,  enteroptosis  (falling  of  the  bowels), 
nervous  indigestion,  nervous  chills  and  cramps  are  applied. 
In  other  cases  the  muscular  system  is  chiefly  or  solely 
affected  in  the  form  of  tremor,  or  of  writer's  cramp,  while  in 
still  others  the  eye,  the  voice,  the  heart  or  the  reproduc- 
tive organs  suffer  most. 

THE  FUNCTIONAL  NERVOUS  DISORDERS — a  large  fam- 
ily— are  manifestations  of  insufficiency  or  impairment  of 
the  brain-and-spine.  Mental  Disorders  of  every  degree 
of  severity  from  simple  crankiness  to  violent  mania 
or  profound  melancholia  or  dementia  often  consist,  or  begin 
in,  brain-and-spine  weakness.  In  certain  stocks  the  brain 
is  an  organ  of  less  resistance  than  the  spine  and  nervous 
over-draft  or  nervous  strain  may  result  in  mental  aliena- 
tion; the  "insane  neurosis"  is  the  great  predisposing 
cause  of  insanity.  Inebriety,  the  diseased  appetite  for 
alcoholic  liquors,  uncontrollable  because  of  enfeebled  will- 
power, is  now  distinguished  from  the  vice  drunkenness 
and  treated  as  a  mental  and  nervous  disease.  Insomnia 


r?6  NERVE    WASTE. 

is  one  of  the  most  constant  symptoms  of  nervous  impair- 
ment. The  Convulsive  Disorders,  Kpilepsy,  St.  Vitus' 
Dance,  Hysteria  and  others,  which  are  manifested  by 
paroxysmal  and  irregular  discharge  of  nerve-force,  depend 
upon  instability  (one  element  of  weakness)  of  the  central 
nervous  system,  and  are  only  radically  cured  by  improv- 
ing the  vitality  and  stability  of  this  part  of  the  body. 
Spermatorrhoea  is  often  a  symptom  of  cerebro-spinal  insta- 
bility as  of  local  reproductive  disorder.  Over-sensitive- 
ness of  nerve-centres  (another  element  of  weakness,) 
is  the  predisposing  cause  of  many  forms  of  Headache  and 
of  Neuralgia.  As  in  the  convulsive  disorders,  the  great 
aim  in  the  radical  treatment  of  these  pains  is  to  improve 
the  integrity  of  the  nervous  structures  Hay-fever,  in  a 
large  proportion  of  cases  consists  in  an  over-sensibility  oi 
the  nervous  centres  connected  with  the  nerve-ends  in  the 
upper  air-passages,  plus  the  excitant  or  irritant,  whatever 
it  may  happen  to  be.  Spasmodic  Asthma  has  a  similar 
condition  of  the  respiratory  nerve-centres  for  its  primary 
causation. 


SURFACE    SIGNS 

Some  years  since  a  distinguished  English  visitor,  Her- 
bert Spencer,  in  the  course  of  a  New  York  address,  said: 

"  Everywhere  I  have  been  struck  with  the  number  of  faces 
which  told  in  strong  lines  of  the  burdens  which  had  to  be  borne. 
I  have  been  struck,  too,  with  the  large  proportion  of  gray-haired 
men,  and  inquiries  have  brought  out  the  fact,  that  with  you  the 
hair  commonly  begins  to  turn  some  ten  years  earlier  than  with  us. 
Moreover,  in  every  circle,  I  have  met  men  who  had  themselves 
suffered  from  nervous  collapse  due  to  stress  of  business,  or  named 
friends  who  had  either  killed  themselves  by  over-work,  or  had  been 
permanently  incapacitated,  or  had  wasted  long  periods  in  endeav- 
ors to  recover  health. 

The  changes  which  excessive  nerve-waste  produces  on 
the  surface  of  the  body  may  be  studied  everywhere  in 
American  business  and  social  life. 

Good  looks  depend  more  upon  health  than  upon 
symmetry.  Every  sound,  wholesome,  fresh  country  boy 
and  girl  is  good  looking,  but  many  society  beauties  will 
not  bear  inspection  in  the  morning.  The  difference 
between  the  plump,  firm,  rosy  cheek  of  youth  and  the 
withered  flabby  one  of  age  is  fundamentally  a  difference 
of  vitality — of  nerve-force. 

EXTREME  THINNESSS,  sometimes  even  to  emaciation 
often  occurs  because  the  fatty  tissues  are  not  sustained  by 
the  blood — the  excessive  demands  of  brain  and  nerve 
lead  them  to  appropriate  the  fat-forming  elements  of  the 
blood  for  force  creation,  and  thus  leave  little  or  none  to 
be  deposited  ds  fat.  This  thinness  is  sometimes  limited 
to  certain  parts  of  the  body,  as  the  face;  in  other  cases 


28  NERVE    WASTE. 

the  face  remains  the  only  plump  part.  A  peculiar  sunken 
and  aged  appearance  of  the  tissues  lying  immediately 
about  the  eye  is  a  sign  which  I  have  frequently  noted  in 
victims  of  overwork  and  of  sexual  excesses. 

BALDNESS,  which  is  said  to  be  increasing  among  Amer- 
icans, is  one  of  the  most  common  results  of  over-activity 
of  the  nervous  system. 

The  three  conditions  of  hair-growing  are  a  blood-cur- 
rent containing  a  sufficiency  of  certain  chemical  sub- 
stances, its  free  circulation  in  the  vessels  of  the  scalp 
and  sufficient  vigor  in  the  hair-follicle  to  attract  the 
blood-stream  and  assimilate  from  it. 

In  cases  of  excessive  nerve-waste  the  demands  of  other 
organs  upon  the  blood  are  imperative;  they  tax  its 
nourishing  and  force-supplying  capacity  to  the  utmost 
molecule.  Thus  when  the  hair  follicles  are,  hereditarily 
or  otherwise,  somewhat  weak  organs,  they  are  robbed  of 
their  food.  In  sedentary  man  the  lazily  acting  heart 
does  not  freely  pump  the  blood  as  far  as  the  hair  follicle, 
and  the  blood  which  is  pumped  there  is  often  obstructed 
for  hours  at  a  time  by  the  pressure  of  hard  hats  upon 
the  nutrient  arteries  of  the  scalp. 

Non-exercise  of  the  scalp  is  one  great  cause  of  bald- 
ness. "A  functional  act  is  a  nutritive  act;  "  that  is,  exer- 
cise of  an  organ  calls  the  blood  into  it  and  thus  the  organ 
is  nourished,  within  certain  limits,  in  proportion  as  it  is 
used.  The  function  of  the  hair  is  to  protect  the  scalp.  In 
animals  the  hair  follicles  are  active;  they  erect  the  hairs  in 
hot  weather  and  apply  them  closely  to  the  skin  in  cold. 
Sedentary  man  covers  his  head  with  hats,  keeps  the  scalp 
at  a  hot-house  temperature,  or  subjects  it  to  the  enervating 
climate  of  rooms.  He  relieves  his  hair  follicles  from  all 
duty  in  protecting  the  head,  and  so  they  degenerate  or 
perish  as  any  other  organ  would  from  non-use. 

In  extreme  thinness  the  absorption  or  the  absence  of  the 
layer  of  fat  which  naturally  lies  between  the  scalp  and 


SURFACE    SIGNS.  29 

the  bony  skull  subjects  the  hair  follicle  to  pressure  and 
thus  favors  atrophy.  An  impaired  nervous  system  poorly 
innervates  or  vitalizes  its  dependent  organs;  the  hair  folli- 
cles become  unable  to  attract  the  blood  current  or  to 
assimilate  from  it  as  it  circulates  through  their  tissues; 
thus  they  become  enfeebled  beyond  the  power  of  stimulus 
to  rouse  them,  or  die  altogether. 

These  ideas  accord  with  the  natural  history  of  baldness. 
This  defect  is  rare  among  non-sedentary  peoples — as 
the  Indian — to  whom  nervousness  is  unknown,  and  in 
women  who  do  not  interfere  with  the  circulation  of  the 
scalp,  nor  maintain  it  at  a  debilitating  temperature,  by 
their  head-gear,  and  who  are  not  often  subjected  to  the 
same  degree  of  nervous  strain  that  men  are.  Thus,  too,  we 
may  understand  the  inefficiency  of  all  the  popular  methods 
of  treating  baldness.  It  is  easy  to  bring  the  blood  into 
the  scalp  by  friction  or  by  stimulating  lotions,  but  an 
enfeebled  hair-follicle  cannot  use  this  blood  more  than  a 
dyspeptic's  stomach  can  use  food.  We  may  lead  a  horse 
to  water  but  we  cannot  make  him  drink.  The  treatment 
of  the  baldness  of  nervous  insufficiency  consists  chiefly  in 
improving  the  vigor  and  resources  of  the  nervous  system, 
as  advised  in  the  later  chapters  of  this  work,  more  than 
in  the  use  of  local  measures. 

THE  TEETH  of  civilized  man  are  not  very  enduring; 
there  are  comparatively  few  Americans  who  are  not  com- 
pelled to  seek  the  services  of  the  dentist  to  rescue  some  of 
these  organs  from  premature  decay.  The  teeth,  like  the 
hair  follicles,  often  deteriorate  because  they  are  not  used 
sufficiently.  Teeth  were  meant  for  biting,  but  civilized 
man  does  but  little  real  biting.  His  food  is  soft,  succu- 
lent, soaked  in  liquids,  and  the  dental  roots  do  not  receive 
that  nutritive  stimulus  which  frequent  firm  pressure  in 
their  sockets  provides.  Impoverished  blood  is  another 
cause  of  decay  in  teeth.  There  is  only  a  certain  available 
quantity  of  phosphates  in  the  blood-stream,  and  if  these 


3O  NERVE    WASTE. 

are  appropriated  by  an  overworked  brain,  little  is  left  with 
which  the  teeth  may  nourish  themselves.  Debility  of 
the  tegumentary  trophic  nerve-centres — those  centres 
which  vitalize  teeth,  skin  and  nails,  and  enable  them  to 
attract  the  blood  stream  and  to  assimilate  from  it  the 
chemical  substances  which  they  require — is  still  another 
element  in  dental  caries. 

Brittleness  and  slow  growth  of  the  nails  is  a  sign  of 
which  the  causation  is  similar  to  that  of  decay  in  teeth. 

ATONY. — The  firmness  of  muscle,  of  artery  and  vein, 
and  to  some  extent  of  surface  flesh  depends  upon  a  steady 
stream  of  nerve-force  from  the  central  nervous  system. 
When  this  nervous  outflow  is  limited  the  tissues  may 
become  lax  and  more  or  less  flabby;  the  flesh  lacks  tone; 
the  veins  may  be  relaxed  and  dilated,  even  to  the  degree 
of  varicosity  or  of  varicocele,  the  face  develops  hard 
lines  or  wrinkles,  and  a  general  atony  may  prevail  at  a 
time  of  life  when  the  tissues  should  be  firm  and  solid. 

ANOMALOUS  APPEARANCE. — While  nervous  impairment 
is  very  apt  to  leave  its  mark  upon  the  surface,  it  does  not 
always  do  so,  and  it  is  a  fact  that  a  high  degree  of  brain- 
and-spine  weakness  may  exist  in  persons  who  are,  to  a 
casual  observer,  the  healthiest  of  men.  This  is  most 
strikingly  exemplified  in  individuals  of  a  mixed  nervo- 
sanguine  temperament,  having  fine  thin  skins  and  plenty 
of  red  blood.  Such  persons  are  sometimes  pictures  of 
rosy  health,  their  digesting  and  blood-making  organs 
being  perfect  while  the  central  nervous  system  is  weak 
and  irritable  in  the  extreme.  These  persons  have  a  rather 
uncomfortable  time  of  it.  Their  sufferings  are  alto- 
gether subjective  and  cannot  be  demonstrated.  They 
are  often  unable  to  make  any  one  believe  that  they  are 
sick,  and  finally  cease  to  try  and  learn  to  bear  their 
troubles  in  silence.  Relatives  who  would  overflow  with 
compassion  for  a  cut  finger  have  no  sympathy  at  all  for 
a  lame  brain-and-spine  because  they  cannot  see  it.  It 


SURFACE    SIGNS.  31 

sometimes  happens  that  such  persons  are  unjustly  blamed 
for  laziness  or  mental  irritability  or  moral  delinquency 
when  they  should  be  cured  (i.  e.,  cared  for). 

The  youthful  appearance  of  many  nervous  invalids  is  a 
phenomenon  which  I  have  repeatedly  noted;  one  is  sur- 
prised to  hear  a  patient  who  looks  not  more  than  twenty- 
five  state  his  age  at  thirty-five  or  forty. 

THE  NEURASTHENIC  VOICE  is  an  objective  symptom 
which  may  be  noted  here.  The  quality  and  quantity 
of  the  voice  is  apt  to  be  temporarily  enfeebled  after 
fevers,  or  any  acute  disease  which  seriously  involves 
the  nervous  system.  In  chronic  nervous  impairment  the 
voice  may  become  permanently  altered.  A  huskiness  or 
hoarseness,  a  soft  quality,  a  lack  of  timbre  and  of  power, 
and  especially  unsteadiness  or  unreliability,  make  up  what 
is  called  the  neurasthenic  voice.  These  changes  are 
caused  by  a  flabbiness  or  lack  of  tone  in  the  vocal  cords 
and  their  adjacent  muscles,  and  in  some  cases  by  a  re- 
laxed congested  state  of  the  mucous  lining  of  the  larynx. 
The  nerves  which  run  to  these  muscles,  as  well  as  the 
nerve-centers  or  batteries  in  the  brain  which  supply  them 
with  force,  are  in  a  state  of  chronic  depression,  either  as 
a  part  of  a  general  brain  depression,  or  as  a  result  of  per- 
sistent reflex  irritation  from  the  stomach,  reproductive 
organs  or  elsewhere. 

The  neurasthenic  voice  is  sometimes  supposed  to  be 
due  to  chronic  laryngitis  or  some  other  condition  of  the 
larnyx,  but  purely  local  treatment  never  cures  it.  It  may 
seem  strange  to  treat  a  husky  voice  by  medicating  the 
stomach  or  womb;  but  as  I  write  I  recall  a  case  of  per- 
sistent huskiness  of  voice  in  a  young  lady,  which  com- 
pletely disappeared  as  soon  as  a  displacement  of  the  womb 
was  cured.  She  had  been  a  fine  singer  and  her  husband 
had  spent  considerable  money  upon  specialists  in  diseases 
of  the  throat  without  any  great  benefit. 


VI 

MENTAL    SIGNS 

The  central  nervous  system  is  trie  seat  and  source  of 
character.  The  difference  between  a  chief-justice  and  a 
sneak-thief  consists  in  the  changes  which  heredity  and 
discipline  have  wrought  in  the  plastic  brain-and- spine. 
And  the  physical  condition  and  the  blood  supply  of  "the 
organ  of  mind"  largely  determine  those  traits  and  char- 
acteristics which  make  up  a  man's  individuality. 

MENTAL  IRRITABILITY  is  a  frequent  manifestation  of 
the  physical  irritability  and  weakness  within.  A  fretful, 
peevish  manner,  an  increasing  irascibility,  a  tendency  to 
become  angered  at  slight  provocation  or  without  provoca- 
tion, an  abnormal  suspiciousness  or  jealousy;  in  woman, 
an  abnormal  emotional  sensitiveness,  sometimes  approach- 
ing hysteria — these  are  trouble-creating  traits  which  may 
be  developed  in  the  most  amiable  individual  as  a  result  of 
nervous  impairment. 

These  exhibitions  are  apt  to  be  looked  upon  as  moral 
failings,  and  met  with  reproach  and  censure,  when  medical 
advice  or  treatment  is  what  is  needed. 

DEPRESSION  OF  SPIRITS  is  a  common  phase.  Poorly 
nourished  brain-cells  cannot  be  expected  to  put  forth  a 
strong,  hopeful,  joyous  quality  of  mind.  The  gloomy 
forebodings  and  the  morbid  fears  of  nervous  impairment 
become  in  some  cases  a  true  insanity,  and  may  even  lead 
to  suicide,  but  more  often  this  phase  takes  the  form  of 
repeated  fits  of  the  blues,  or  of  hypochondria.  In  this 
latter  condition  the  subject  feels  that  he  is  sick,  and  his 
attention  once  fixed  upon  his  condition,  develops  into  a 
morbid  habit  of  introspection;  he  exaggerates  the  mean- 
ing of  all  his  symptoms  and  fears  the  worst  consequences. 

(32) 


MENTAL    SIGNS.  33 

Thousands  of  medical  vampires  deliberately  do  all  in 
their  power  to  cultivate  this  wretchedness,  and  derive 
large  incomes  by  playing  upon  this  phase  of  nervous 
impairment. 

PATHOPHOBIA  means  "fear  of  disease."  An  irritated, 
over-sensitive,  or  impoverished  brain-and-spine  is  apt  to 
be  uneasy  about  itself.  It  watches,  notes  symptoms, 
worries.  This  morbid  sensitiveness  about  health  has 
become  an  American  trait.  No  other  people  swallow  so 
much  medicine,  nor  support  so  many  physicians,  nor 
become  the  prey  of  charlatans  to  such  an  extent  as 
Americans.  This  trait  is  not  wholly  imagination;  it  is  a 
sign  manifested  by  nervous  systems  irritated  by  the  rest- 
less, disproportionate  activity  of  American  life. 

IMPAIRMENT  OF  MEMORY. — The  process  by  which  ex- 
ternal impressions  become  fixed  forever  in  the  mind  has 
been  compared  to  photography — the  highly  sensitive 
particles  of  brain  matter  corresponding  to  the  highly  sensi- 
tized plate  in  the  camera.  Every  impression  is  brought 
to  the  brain  through  the  special  senses  of  sight,  hearing, 
taste,  touch  and  smell;  and  every  thought  and  imagina- 
tion of  the  mind  is  supposed  to  be  registered — that  is,  to 
produce  certain  molecular  changes  in  the  brain-cells. 
But,  since  these  brain-cells  are  being  constantly  worn  out 
and  destroyed,  and  the  life  of  the  individual  cell  is 
transient,  how  is  it  that  this  registration  is  permanent  ? 
This  is  explained  by  applying  the  law  of  heredity  to  cell- 
life.  Within  every  cell  is  a  spot  or  germ,  which,  as  the 
cell  itself  is  passing  through  the  various  terms  of  its 
existence,  gradually  develops,  and  eventually  takes  the 
place  of  the  parent  cell,  carrying  on  all  the  molecular 
peculiarities  of  the  parent  cell. 

The  vigor  of  the  memory  is  apt  to  be  in  direct  pro- 
portion to  the  vigor  of  the  brain-cell.  In  youth,  memory 
is  keen,  and  many  of  the  impressions  registered  in  the 
substance  of  the  brain  during  that  period  of  life  are 


34  NERVE    WASTE. 

remembered  vividly  in  extreme  old  age,  while  impres- 
sions brought  to  the  comparatively  blunted  and  enfeebled 
brain-cells  of  old  age  are  forgotten  in  a  week  or  a  day. 
This  illustrates  how  it  is  that  an  enfeebled  condition  of 
the  brain-centers  is  apt  to  be  manifested  by  a  failing  mem- 
ory. The  cells,  poorly  nourished  by  thin  blood,  or 
impoverished  by  an  excessive  expenditure  of  their  reserve 
force,  become  sluggish,  blunted,  unimpressionable  at  any 
age,  just  as  they  do  in  the  natural  failing  power  of 
extreme  old  age.  Many  degrees  of  impairment  of  mem- 
ory are  met  with.  Of  course,  the  capacity  of  the  brain 
to  register  impressions  has  its  limits.  A  three  weeks' 
tour  of  Kurope  is  apt  to  leave  indistinct  and  confused 
memories.  A  man  whose  business  involves  the  remem- 
brance of  a  vast  number  of  details,  may  have  a  very  poor 
memory  for  things  outside  the  range  of  that  business, 
without  having  any  degree  of  brain  or  nerve  impairment. 
Closely  related  to  this  impairment  of  memory  is  an 

IMPAIRMENT  OF  THE  FACULTY  OF  SPEECH. — The  power 
of  speech  requires  a  more  or  less  normal  condition  of 
the  vocal  organ  in  the  throat — the  larynx,  of  the  mus- 
cles concerned  in  articulation — those  of  the  tongue  and 
lips,  and  of  the  resounding  chambers  or  cavities  in  and 
adjacent  to  the  throat  and  nose.  But,  in  addition,  it 
requires  the  more  or  less  healthful  condition  of  certain 
brain-cells,  the  speech-centers,  in  which  reside  the  faculty 
of  language,  or  that  part  of  intelligence  which  associates 
certain  words  with  certain  ideas. 

A  fluent  speaker  is  one  in  whom  the  speech-center  in 
the  brain  is,  by  heredity  or  by  cultivation,  highly  devel- 
oped. This  instinct  for  words  may  be  extraordinary  in 
persons  who  are  not  fluent  talkers  ;  some  of  the  most 
famous  authors  have  been  comparatively  stupid  compan- 
ions, or  have  been  totally  unable  to  make  a  speech  in 
public.  Children  born  deaf,  or  becoming  deaf  from  early 
sickness,  remain  dumb,  not  because  the  vocal  organs 


MENTAL    SIGNS.  35 

are  at  fault,  but  because  the  speech-center  in  the  brain 
cannot  be  sufficiently  educated  without  hearing.  When, 
as  a  result  of  over  brain-work,  the  vigor  of  the  cells  of 
the  speech  center,  in  common  with  other  parts  of  the  brain, 
becomes  impaired,  the  subject  may  be  noticed  to  fre- 
quently mis-use  words,  or  syllables,  or  even  single  letters, 
generally  the  initial  letter  of  words  ;  and  he  may  be  often 
at  a  loss  for  a  familiar  word.  This  impaired  fluency  of 
speech  is  not  constant ;  the  individual  may  be  a  strong 
and  eloquent  speaker  under  the  stimulus  of  certain  sur- 
roundings, but  in  his  enervated,  listless  moments,  when 
the  brain  is  more  or  less  off  duty,  this  phase  may  be  very 
conspicuous. 

IMPAIRMENT  OF  WILL  POWER. — Volition  is  the  rarest 
and  most  valuable  quality  of  mind.  There  are  a  hun- 
dred men  who  are  wise  for  one  who  is  strong,  and  the 
man  with  a  strong  will  is  apt  to  control  his  fellows.  In 
many  cases  of  nervous  impairment,  weakening  of  the 
will  power  is  very  noticeable.  A  patient  lately  informed 
me  that  he  had  left  home  immediately  after  breakfast  to 
have  an  aching  tooth  drawn,  but,  though  he  had  fully 
decided  that  the  tooth  must  be  removed,  he  could  not 
bring  himself  to  enter  the  dentist's  office  ;  he  passed  and 
repassed  the  door  innumerable  times,  and  it  was  noon  be- 
fore he  could  force  himself  to  enter  and  submit  to  the 
momentary  operation.  This  incident  by  itself  is  not 
proof  of  an  impaired  will,  but  when  such  a  peculiarity 
developes,  as  it  did  in  this  case,  in  a  man  to  whose  known 
character  it  is  utterly  foreign,  then  it  is  so.  My  patient 
had  visited  the  dentist  many  times  before  without  shrink- 
ing, and  his  acquired  enfeeblement  of  will  was  manifested 
in  other  directions.  Fickleness,  inconstancy,  wavering, 
and  inability  to  concentrate  the  mind,  or  to  long  apply  it 
to  study  or  work,  are  often  the  manifestations  of  an 
acquired  enfeeblement  of  will,  and  may  seriously  affect 
the  business  or  social  interests  of  the  individual.  The 


36  NERVE   WASTE. 

patriarch's  "Unstable  as  water,  thou  shalt  not  excel" 
well  describes  some  of  these  cases.  This  impairment  of 
will  power  is  not  unfrequently  exhibited  in  old  and 
wealthy  families,  where  the  stock  is  retrograding  from  a 
lack  of  earnest  work,  combined  with  dissipation,  and  it  is 
one  of  the  serious  consequences  of  several  of  the  drug 
habits,  notably  of  morphine  and  of  chloral  addiction. 

UNEVENNESS  is  one  of  the  characteristic  phases  of  ner- 
vous impairment,  which  often  renders  the  subject  an 
enigma  to  his  friends.  Not  only  the  state  of  mind,  but 
all  the  subjective  sensations  of  the  disorder  are  liable  to 
sudden  and  frequent  changes.  One  day  such  a  man  may 
be  active  and  enthusiastic,  the  next  fatigued  and  de- 
pressed. One  day  he  may  be  cheerful,  or  even  vivacious; 
the  next  silent,  inelastic,  listless.  The  functions  of 
digestion  and  reproduction  are  liable  to  sudden  break- 
downs, or  to  periods  of  enfeeblement.  Thus  the  neu- 
rasthenic invalid  is  apt  to  be  in  business  and  in  society 
a  noticeably  uneven  man. 


VII 


CIRCULATION    SIGNS 

The  vessels,  by  means  of  which  the  blood  circulates 
through  every  part  of  the  body,  are  not  rigid  and  unyield- 
ing tubes,  but  have  the  property  of  dilating  and  contract- 
ing. These  changes  of  calibre  occur  under  a  great  variety 
of  circumstances.  In  the  moment  of  sudden  fear  the  blood 
recedes  from  the  skin  and  rallies  around  the  vital  organs 
within  as  if  to  protect  them — the  face  is  <(  blanched  with 
terror  ;"  under  the  stimulus  of  another  emotion  the  ves- 
sels of  the  skin  dilate,  and  the  blood  rushing  in  to  fill 
them  causes  the  blush  of  shame  ;  when  the  body  is 
exposed  to  cold,  the  blood-vessels  of  the  skin  contract  and 
the  blood  is  partially  withdrawn  from  the  surface,  in 
order  that  it  may  be  kept  hot,  and  not  radiate  its  heat  too 
rapidly  into  the  cold  air  ;  under  the  influence  of  heat  the 
blood  is  led  into  the  skin,  that,  by  radiation  and  by  evap- 
oration of  sweat,  the  body  may  lose  part  of  its  super- 
fluous heat ;  during  study  or  earnest  thought  the  blood- 
wave  is  attracted  to  the  brain  ;  during  and  after  digestion 
to  the  stomach  and  other  digestive  organs. 

The  duty  of  managing  these  complicated  circulation 
changes  belongs  to  a  certain  part  of  the  nervous  system  of 
organs  known  as  the  vaso-motor  system.  This  system 
consists  of  central  collections  of  nerve -cells  and  innumer- 
able thread-like  nerves  which  run  along  in  the  walls  of 
every  blood-vessel  in  the  body.  In  health  all  goes  well, 
but  when  the  nerve-cells  of  the  central  nervous  system 
become  weakened  or  irritable,  the  action  of  the  dependent 
vaso-motor  nerves  is  apt  to  become  deranged  and  un- 
steady, the  abnormally  susceptible  blood-tubes  are  not 

I  37) 


38  NERVE    WASTE. 

properly  controlled,  and  certain  circulation  derangements 
result.  One  of  the  most  common  of  these  is  partial  con- 
gestion of  the  brain.  Brain  exercise  attracts  a  large 
quantity  of  blood  into  the  brain-vessels,  which,  when  the 
brain  exercise  is  at  an  end,  should  be  made  to  recede 
from  the  brain  by  the  contraction  of  the  blood-vessels  ; 
but  if  the  supply  of  nerve-force  to  these  blood-vessels  is 
insufficient,  they  are  sluggish,  lack  tone,  and  cannot  con- 
tract; the  brain  remains  engorged  with  blood,  and  we  may 
have  a  Congestive  Headache,  or  perhaps  a  persistent  Sleep- 
lessness. Or,  the  blood-flow  to  the  brain  may  be  too 
small,  causing  An<zmic  Headache,  vertigo  or  dizziness, 
and  a  variety  of  sensations  referable  to  the  head,  eyes  and 
ears.  The  Excessive  Blushing  which  so  annoys  some 
patients,  and  the  Hot  Flashes  experienced  by  many 
women  about  the  change  of  life,  are  examples  of  this 
unsteadiness  of  the  circulation  resulting  from  a  weakened, 
or  an  irritated  nervous  system. 

There  may  be  constant  coldness  of  the  feet  and  hands, 
or,  on  the  other  hand,  the  extremities  may  be  warm  and 
perspiring,  according  as  the  blood-current  is  over  or 
under  the  normal  supply  to  these  parts.  Almost  any 
organ  in  the  body  may  be  affected  by  these  irregularities 
of  blood  supply.  A  congested  and  abnormally  sensitive 
condition  of  the  spinal  cord,  with  or  without  some  dis- 
order of  the  reproductive  organs,  is  a  common  symtom 
among  women,  known  as  Spinal  Irritation,  or  the  Irri- 
table Spine.  The  Irritable  Ovary  and  the  Irritable  Uterus 
are  terms  which  imply  an  irritable,  congested  and  relaxed 
condition  in  those  organs.  In  the  male  a  relaxed,  con- 
jested  and  hyper-sensitive  state  of  certain  deep-seated 
parts — the  uretha,  the  prastate  gland,  and  parts  adja- 
cent— are  often  the  conditions  keeping  up  Spermatorrhoea 
and  Impotency.  One  form  of  weak  and  irritable  eyes 
depends  upon  a  state  of  chronic  congestion  in  the  mucous 
membrane  of  the  eye — the  conjunctiva. 


CIRCULATION    SIGNS.  39 

THE  IRRITABLE  HEART— Palpitation  of  the  heart  is 
one  of  the  most  common  symptoms  of  nervous  debility, 
and  one  which  sometimes  causes  much  uneasiness  or  alarm. 
The  heart  is  a  hollow  muscle,  swung  somewhat  freely  in 
the  chest,  whose  business  it  is  to  keep  the  blood  in  motion. 
It  acts  as  a  pump,  receiving  the  dark  blood  from  the  veins 
and  forcing  it  into  the  lungs,  where  it  is  purified  and  red- 
dened by  contact  with  oxygen;  thence  it  again  receives 
this  red  oxygen-laden  blood  and  pumps  it  to  every  organ 
and  tissue,  through  hundreds  of  elastic  tubes — the  arte- 
ries. 

The  power  or  force  that  keeps  the  heart  moving,  day 
and  night,  comes  from  the  nervous  system,  just  as  the 
force  that  vibrates  the  hammer  of  an  electric  bell  comes 
from  the  galvanic  battery.  While  this  supply  of  nerve 
force  flows  out  to  the  muscular  fibres  of  the  heart  in 
proper  quantity,  that  organ  beats  strongly,  steadily,  and 
with  a  certain  rhythm.  But  if  the  nerve-cells,  or  batteries, 
of  the  nervous  system,  become  weakened  by  over-expen- 
diture, two  things  may  happen,  first,  the  nerve-cells  can 
not  give  out  a  strong  current  of  force  to  properly  main- 
tain the  beating  of  the  heart;  second,  one  certain  nerve, 
whose  duty  it  is  to  maintain  the  rhythm  of  the  heart,  by 
keeping  it  to  a  certain  number  of  beats  per  minute,  par- 
tially loses  its  governing  power,  and  becomes  more  or  less 
unreliable.  These  two  conditions  of  nerve  weakness 
cause  palpitation  of  the  heart, — a  weak  action  of  the 
heart  because  of  a  feeble  outflow  of  nerve  force,  and  a 
rapid,  irregular  action  because  of  the  inability  of  the 
pneumogastric  nerve  to  properly  do  its  duty.  Palpitation 
of  the  heart,  in  the  great  majority  of  cases,  is  not  a 
symptom  of  heart  disease,  as  that  term  is  used  by  medical 
men;  it  is  not,  in  itself,  dangerous  to  life,  and  never 
results  in,  or  causes  sudden  death. 

I  have  met  men  and  women  suffering  from  this  symp- 
tom, who  firmly  believed  themselves  to  be  the  victims  of 


4O  NERVE    WASTE. 

heart-disease,  and  over  whose  heads  the  fear  of  sudden 
death  had  hung  for  months  or  years.  They  had  obtained 
this  idea  from  the  representations  of  some  patent  medicine 
advertisement,  or  from  the  statement  of  some  ignorant  or 
unscrupulous  physician.  It  is  a  sad  fact  that  there  are  men 
who,  in  order  to  extort  a  petty  sum,  will  subject  a  fellow 
human  being  to  a  mental  misery  which  may  endure  as 
long  as  life  itself.  There  is  no  more  terrible  news  to  hear, 
and  no  heavier  burden  for  the  sick  to  bear,  than  the  con- 
viction that  they  have  incurable  disease  of  the  heart. 
Palpitation  of  the  heart  is  cured  by  gradually  building  up 
the  nervous  system,  and  by  the  use  of  medicines  having  a 
direct  tonic  action  upon  the  heart,  of  which  medical 
science  has  several  of  great  value. 

Closely  related  to  the  unstable  circulation  of  nervous 
impairment  are  certain 

DISORDERS  OF  SECRETION  AND  EXCRETION. — The  skin 
contains  immense  numbers  of  sweat-glands  whose  function 
it  is  to  excrete,  or  separate  from  the  blood,  certain  waste 
substances  in  solution;  so,  too,  the  pink,  shining  mucous 
membrane  lining  those  cavities  of  the  body  which  com- 
municate with  the  air,  and  which  is  a  kind  of  internal 
skin,  is  studded  with  innumerable  follicles  which  secrete, 
or  separate  from  the  blood,  a  thin  fluid  mucus.  This  mu- 
cus serves  to  protect  the  parts,  to  keep  them  moist  and 
pliable,  and,  by  being  constantly  removed  and  changed,  it 
keeps  the  parts  clean .  Both  these  sets  of  glands  are  under 
the  direct  influence  of  certain  nerve-cells,  and  in  nervous 
impairment,  this  excito-secretory  office  of  the  nervous 
system  may  become  disordered,  unsteady,  over  or  under 
the  normal  degree  of  activity,  causing  Excessive  Perspira- 
tion of  the  hands  or  feet,  or  of  the  whole  body;  or  in  other 
cases  an  Unnatural  Dryness  of  the  Skin,  or  an  Abnormal 
Dryness  of  the  Mouth  and  Throat. 


VIII 

THE    ACHES,    PAINS    AND    FEELINGS    OF   NERVOUS 
IMPAIRMENT 

The  apparatus  of  sensation  includes  :  i .  The  brain, 
which  is  the  great  central  receptive  organ.  2.  The  nerves, 
which  conduct  impressions  from  every  part  of  the  body 
'to  the  brain.  3.  The  nerve-ends  in  eye,  ear,  tongue, 
nose,  skin  and  elsewhere,  which  are  the  perceptive  part 
of  the  apparatus.  Healthy,  nervous  tissue  perceives, 
conducts  and  receives  natural  impressions  without  pain  or 
discomfort,  but  weakened,  poorly  nourished,  morbidly 
sensitive  nervous  tissues  do  not  always  do  so. 

HEADACHE. — The  head  may  ache  from  a  great  variety  of 
causes,  and  the  headache  of  nervous  impairment  is  only 
one  of  a  large  family.  Thus  the  head  may  ache  : 

1 .  When  the  brain  is  irritated  or  pressed  upon  by  some 
foreign  substance,  as  a  brain  tumor,  abcess  or  meningitis. 

2.  When  the  blood  pressure  within  the  brain  is  in- 
creased by  any  derangement  of  the  circulation.    This  may 
be  the  result  of  exposure  to  cold,  of  over  brain- work,  of 
heart  disease,  of  kidney  disease,  or  of  the  unsteady  cir- 
culation of  nervous   impairment. 

3.  When   the   brain  is  harassed  by   any  continuous 
morbid  impression  brought  to  it  from  distant  parts;   thus 
the  disordered  stomach  of  the  dyspeptic  sometimes  irri- 
tates his  brain  into  aching. 

4.  When   the   blood   is   charged   with   unnatural   or 
with  poisonous  substances;  a  large  dose  of  quinine  causes 
headache  in  most  persons  ;  the  blood-poisoning  of  Bright's 
disease  often  gives  rise  to  terrible  head  pains.     Exposure 
to  cold  acts  partly  in  this  way  ;  the  function  of  the  skin, 

(41) 


42  NERVE    WASTE. 

an  important  excretory  organ,  being  suppressed  for  a  time, 
various  poisonous  substances  are  imprisoned  in  the  blood. 

5.  When  the  brain   is  chronically   tired,  as  in   eye- 
strain  and  ear-strain,  or  in  regular  over  brain- work  it  may 
ache  just  as  a  muscle  would. 

6.  When  the  brain  is  imperfectly  nourished  by  poor 
quality  of  blood. 

The  headaches  01  nervous  impairment  are  variously  de- 
scribed as  a  feeling  of  fullness,  or  a  tight  band-like  feeling 
about  the  temples,  or  a  heavy  tender  feeling  at  the  crown 
of  the  head  or  in  the  back  of  the  neck.  They  are  ex- 
plained by  the  unsteady  circulation  of  the  blood  described 
in  a  preceding  chapter,  by  the  over-sensibility  to  reflect- 
ed irritations,  which  is  a  characteristic  of  weakened  nerve- 
cells,  and  in  some  cases  by  brain-tire  from  strain  and  over 
brain-exercise. 

MIGRAINE,  OR  SICK  HEADACHE,  is  a  peculiar  form  of 
headache  to  which  many  nervously  impaired  persons  are 
periodically  subject.  A  typical  sick  headache  is  ushered 
in  by  brow  uneasiness,  or  by  painful  disturbances  of  vision, 
and  chilly  sensations  which  continue  for  a  time,  varying 
from  a  few  minutes  to  several  hours.  These  disorders  of 
sensation  gradually  pass  into  headache,  often  limited  to 
part  of  the  head,  and  often  attended  by  nausea  or  vomit- 
ing. The  stage  of  headache  is  apt  to  last  several  hours 
and  leave  the  patient  weary  and  depressed,  though  after 
the  immediate  effects  have  passed  away  many  persons 
feel  better  than  usual — a  fact  probably  explained  by  the 
enforced  rest,  abstinence  from  food,  and  vomiting.  The 
attacks  may  occur  every  few  days  or  as  rarely  as  once  in 
several  years,  or  even  once  in  a  lifetime. 

Neurologists  are  not  agreed  upon  the  real  nature  of 
sick  headache.  It  was  formerly  supposed  to  be  due  to 
liver  or  stomach  derangements,  but  these  are  now  known 
to  be  only  exciting  causes,  bearing  the  same  relation  to 
the  brain  that  an  ignited  fuse  bears  to  a  mine  of  powder. 


SENSATION    SIGNS.  43 

Dr.  lyiveing  has  written  an  exhaustive  work  on  this 
form  of  headache,  in  which  he  asserts  that  it  is  a  pain- 
storm  traversing  certain  tracts  in  the  brain.  The  theory 
most  commonly  held  refers  migraine  to  the  sympathetic 
nervous  system.  This  system,  which  consists  of  chains 
of  nervous  ganglia  in  the  head,  neck,  chest,  abdomen  and 
pelvis,  is  controlled  by  the  brain-and-spine.  In  a  weak- 
ened brain-and-spine  this  controlling  or  inhibiting  influ- 
ence is  impaired,  and  the  sympathetic  system  runs  riot. 
The  sympathetic  system  controls  the  blood-stream,  and 
it  at  first  contracts  the  blood-vessels  in  its  uncontrolled 
excitement,  causing  the  visual  and  other  disordered  sen- 
sations of  the  first  stage.  Later,  its  excitement  is  followed 
by  temporary  exhaustion  or  paralysis,  whence  results  dila- 
tation of  blood-vessels,  brain-fullness  and  headache. 

Migraine  is  a  disorder  of  the  first  half  of  life  ;  after 
thirty  or  forty  the  attacks  diminish  in  frequency  ^nd 
finally  cease. 

In  many  cases  of  impending  sick  headache,  temporary 
seclusion  and  rest,  or,  it  may  be,  cheerful  change,  will 
ward  off  the  attack.  In  others  warmth,  a  hot  mustard 
foot-bath  (if  the  feet  are  cold),  or  hot- water  rubber  bottles 
to  spine  and  neck,  a.  cup  of  strong  coffee,  a  little  hot 
bouillon  or  a  glass  of  wine  internally,  and  an  evaporating 
lotion,  or  cloths  wrung  in  ice- water,  may  be  added,  and 
will  suffice.  Purgatives  are  of  great  use  in  the  beginning 
of  sick  headache;  five  grains  of  calomel,  mineral  waters, 
two  or  three  teaspoonfuls  of  Tarrant's  seltzer  aperient,  or 
a  dose  of  the  individual's  favorite  "liver  pill,"  maybe 
used  upon  the  first  warning  of  the  approach  of  migraine. 
S.ilicylate  of  soda  has  a  reputation  for  preventing  migrain- 
ous  attacks,  which  it  sometimes  realizes;  it  is  not  without 
danger  to  the  kidneys,  and  is  not  suitable  for  self-treat- 
ment. 

VERTIGO,  OR  DIZZINESS. — The  physiology  of  equipoise 
is  quite  intricate.  First,  our  perceptive  organs  (of  vision, 


44  NERVE    WASTE. 

hearing,  and  touch)  give  us  evidence  of  our  relation  to 
outside  objects.  The  evidence  of  these  various  impres- 
sions is  transmitted  by  the  nerves  to  the  cerebellum,  or 
little  brain,  which  is  the  co-ordinating  centre,  or  home 
office,  of  equilibration.  The  cerebellum  acting  upon  this 
evidence  sends  out  nervous  impulses  to  various  muscles, 
chiefly  those  of  the  head,  neck  and  spine,  by  the  proper 
contraction  of  which  we  are  able  to  maintain  our  equi- 
poise. When  any  of  the  three  parts — perceptive,  co-ordi- 
nating or  motor — of  this  mechanism  is  disordered  we  may 
have  vertigo.  It  occurs  in  certain  diseases  of  the  eye  and 
of  the  ear,  because  it  is  largely  by  the  aid  of  these  organs 
that  a  man  unconsciously  takes  his  bearings.  It  occurs 
in  several  organic  diseases  of  the  brain  and  of  the  spine, 
in  epilepsy,  in  certain  diseases  of  the  stomach,  and  in 
gout.  It  frequently  complicates  sick  headache  and  some- 
times replaces  it.  It  occurs  in  simple  nervous  impair- 
ment from  an  unsteadiness  of  the  entire  nervous  appa- 
ratus of  equilibration. 

SPINE  PAINS  and  morbid  sensations  are  among  the 
most  common  symptoms  of  nervous  impairment,  espec- 
ially of  spinal  neurasthenia. 

The  back  of  the  neck  and  the  region  of  the  spine,  ex- 
tending from  the  hair  to  a  point  just  below  the  shoulder 
blades,  is  the  most  common  seat  of  sensations  variously 
described  as  a  sore,  tender  feeling  "deep  in,"  a  dull  ache, 
or  an  uncomfortable,  irritating,  burning  sensation  in  the 
skin  ;  a  dull  ' '  headache  in  the  back  ' '  may  be  experienced 
at  any  point  along  the  spine, 

Spinal  Irritation,  a  sensation  of  pain  or  of  irritability, 
usually  located  in  the  lower  part  of  the  back,  is  a  some- 
what common  symptom  among  women.  It  indicates  con- 
gestion and  over-sensibility  of  the  spinal  cord  at  the  cor- 
responding point;  and  is  in  most  cases  due  to  the  harass- 
ing, depressing  influence  of  ovarian  or  uterine  disease. 


SENSATION    SIGNS.  45 

Similar  sensations  are  sometimes  met  with  in  the  male  in 
cases  of  sexual  debility  and  exhaustion. 

NERVE  PAINS. — -Neuralgia  has  been  cleverly  called 
"the  prayer  of  a  starved  nerve  for  food."  But  this  is 
not  always  the  case,  and  nerves  may  ache  from  a  variety 
of  causes,  e.  g.  : 

1.  Exposure   to   cold,   resulting   in    congestion   and 
pressure  about  the  nerve. 

2.  Poisoning;  the  impure  blood  stream  of  gout,  rheu- 
matism, lithaemia,  malaria,  or  of  any  metallic  poisoning 
may  irritate  the  nerves  and  set  them  to  aching. 

3.  Organic  nervous  diseases,  as  inflammation  of  the 
nerve  itself,  or  disease  of  the  spinal  cord. 

4.  Reflex  irritation,  as  when  one  decaying  tooth  lights 
up  a  neuralgia  of  half  the  face. 

5.  Over- worked  and  under-nourished  nerve-centres  are 
more  sensitive  to  all  the  exciting  causes  just  mentioned, 
but   they  may  ache  without   any  discoverable  exciting 
cause  whatever.     The  neuralgias  of  nervous  impairment 
are  common  in  the  face  (brow-pains  and  tic),  in  the  head, 
in  the  chest- wall,  in  the  leg  (sciatica),  and  may  occur  in 
any  nerve. 

Tic  DOULOUREUX,  Facial  Neuralgia,  Prosopalgia,  is 
peculiar  in  the  rapidity  of  its  approach  and  in  the  abrupt- 
ness of  its  departure,  in  the  intensity  of  the  pain,  in  the 
muscular  spasm  which  it  often  induces  and  in  the  obsti- 
nacy with  which  it  resists  treatment.  Hither  or  all  of  the 
three  divisions  of  the  tri-facial  nerve  may  be  attacked. 
The  term  ' '  brow-ague ' '  supposes  a  malarial  (exciting) 
causation.  The  opthalmic  variety  of  tic  is  sometimes  con- 
founded with  migraine,  but  falls  far  short  of  migraine. 
The  sudden  spasmodic  contractions  of  the  facial  muscles 
which  attend  certain  cases  of  tic  douloureux  have  caused 
the  term  ' '  epileptiform  neuralgia  "  to  be  applied  to  it  ; 
the  muscles  about  the  eye,  those  of  the  face,  and  in  some 
cases  those  of  all  the  face  and  neck  may  be  involved  in 


46  NERVE    WASTE. 

spasm.  The  hair  is  very  apt  to  turn  gray  about  the  seat 
of  pain,  and  between  attacks  superficial  ansethesia  in  some, 
exquisite  sensitiveness  in  others,  may  be  marked. 

There  may  be  a  dull  aching  sensation  along  the  course 
of  the  nerves  of  the  arm  or  leg  not  amounting  to  actual 
pain,  or  a  feeling  of  numbness  may  be  experienced  in 
some  part.  These  limb  sensations  are  sometimes  sup- 
posed to  be  forerunners  of  paralysis,  and  are  thus  the 
cause  of  much  unnecessary  uneasiness  or  alarm.  They 
merely  indicate  the  impoverished  state  of  nerve  nutrition 
and  are  never  followed  by  paralysis.  Electricity  often 
removes  these  symptoms,  as  well  as  those  located  in  the 
spine,  as  if  by  magic,  and  neuralgia  itself  is  often  quickly 
cured  or  greatly  benefited  by  proper  treatment. 

The  avoidance  of  neuralgic  attacks  involves  especially 
two  things,  viz.,  the  avoidance  of  cold,  and  of  the  blood- 
poisoning,  lithsemia,  which  results  from  over-eating  and 
under-breathing.  Urinary  deposits  are  a  sign  that  some- 
thing in  diet  or  in  habits  needs  adjustment. 

NERVE-END  PAINS. — Paraesthesias,  or  morbid  sensa- 
tions on  the  external  or  the  internal  surfaces  of  the  body, 
are  very  common  in  nervous  impairment.  Tenderness  in 
the  scalp,  tenderness  about  the  teeth  and  gums,  or  at 
almost  any  point ;  creeping  or  crawling  sensations  ;  itch- 
ing of  the  skin ;  exaggerated  sensations  of  heat  or  of 
cold  ;  feelings  of  numbness  ;  ' '  burning  in  the  nerves  ' '  of 
the  face  or  any  part  of  the  surface  ;  smarting  in  the  womb 
or  vagina  or  rectum  ;  soreness  in  the  muscles;  a  sore, 
tender  feeling  and  sense  of  relaxation  in  the  joints  of  knee, 
elbow  or  jaw;  a  feeling  of  tenderness  or  soreness  in  the 
heels,  are  among  the  subjective  signs,  described  by  differ- 
ent patients. 

VISCERAL  NEURALGIAS. — The  nerves  which  innervate 
the  internal  organs  may  ache  as  well  as  the  superficial 
nerves.  Angina  Pectoris^  "  breast-pang,"  is  a  terrifying 
combination  of  spasm  and  pain  in  the  region  of  the  heart, 


SENSATION    SIGNS.  47 

of  which  each  attack  is  said  to  bring  the  fear  and  suffer- 
ing of  death  itself.  It  is  like  migraine,  an  uncontrolled 
action  of  the  sympathetic  nervous  system,  and  in  many 
cases  depends  upon  organic  disease  of  the  heart.  Gastral- 
gia  (gastrodynia,  cardialgia,  gastric  colic)  ranges  all  the 
way  from  uneasy  sensations  in  the  stomach  on  taking  food 
to  severe  paroxysms  of  stomach  pains.  Enteralgia,  neural- 
gia of  the  bowels,  is  somewhat  common  in  abdominal 
neurasthenia.  Hepatalgia,  neuralgia  of  the  liver,  occurs, 
but  rarely.  Uterine  and  Ovarian  neuralgias  are  common 
and  often  develop  without  any  discoverable  local  causa- 
'tion;  I  have  seen  cases  of  neuralgia  of  the  urethra  and 
of  the  testicles.  Neuralgia  of  the  rectum  and  of  the  anus 
are  occasionally  met  with. 

AN  UNNATURAL  FATIGUE  may  be,  for  a  time,  the  only 
indication  of  failing  nerve-power.  The  accustomed  duties 
of  life  may  become  excessively  irksome,  and  a  constant 
feeling  of  weariness  may  be  experienced.  In  some  cases 
work  is  well  done  under  the  stimulus  of  duty,  but  after- 
noon or  evening  brings  an  intolerable  feeling  of  fatigue. 
Or  the  best  sleep  may  be  insufficient  to  repair  the  over- 
drawn nervous  system,  and  the  individual  arises  from  his 
bed,  after  having  slept  soundly  eight  or  nine  hours,  unre- 
freshed,  inelastic  and  languid,  and  it  may  be  several 
hours  before  he  becomes  braced  up  for  the  day's  duties. 
When  this  abnormal  tiredness  occurs  in  an  apparently 
healthy  man  he  is  apt  to  be  suspected  of  laziness  and  to 
get  but  little  sympathy. 

SPECIAL  SENSE  SIGNS. — The  visual  apparatus  with  its 
exquisite  perception,  and  its  delicate  adjustment,  is  liable 
to  several  disorders  in  nervous  impairment. 

The  mucous  membrane  lining  the  front  of  the  eye  and 
orbit — the  conjunctiva — may  become  congested,  red  and 
watery  as  one  of  the  results  of  a  disordered  circulation. 
The  perceptive  part  of  the  apparatus — the  retina,  optic 
nerve,  and  in  the  brain  the  great  central  sensory  ganglion, 


48  NERVE    WASTE. 

the  optic  thalamus,  may  participate  in  the  general  nervous 
weakness  and  irritability.  Floating  specks  and  wavy  lines 
in  the  field  of  vision,  running  together  or  blurring  of  the 
letters  in  reading,  momentary  blindness,  and  a  feeling  of 
fatigue  on  using  the  eyes  are  common  symptoms  of  ocular 
neurasthenia. 

An  unnatural  dilation  of  the  pupil  is  often  noticeable 
in  nervous  impairment.  It  is  explained  by  weakness  of 
the  motor  oculi  nerve-sources  (whence  pupillary  contrac- 
tion) plus  unrestrained  action  (inhibition  failure) ,  of  those 
sympathetic  fibres  of  the  opthalmic  ganglion  which  dilate 
the  pupil. 

The  ear  may  become  the  seat  of  various  annoying 
sensations,  indicative  of  feeble  and  unsteady  nervous  out- 
flow. Ringing,  buzzing,  tapping  and  roaring  sounds  in 
the  ear  are  occasionally  complained  of.  These  noises  are 
sometimes  very  persistent.  In  one  case  a  patient  had 
hardly  been  free  from  a  ringing  in  the  ear  for  more  than  a 
year;  at  first,  as  she  said,  it  almost  drove  her  crazy,  but 
she  finally  became  accustomed  to  it. 

The  nerve-ends  for  smell  in  the  nose,  and  those  for  taste 
in  the  tongue,  are  liable  in  rare  cases  to  functional  perver- 
sions, and  the  individual  is  annoyed  by  unnatural  odors 
or  tastes.  In  other  cases  the  acuteness  of  these  senses  is 
greatly  diminished. 

The  treatment  of  neurasthenic  pain  is  palliative  or  tem- 
porary and  curative  or  permanent;  the  former  is  accom- 
plished by  stimulation  and  sedation,  the  latter  by  the 
whole  hygiene  of  the  nervous  constitution.  Electricity 
is  the  most  valuable  single  remedy  in  both  the  palliation 
and  cure  of  neurasthenic  pain. 


IX 


MUSCULAR 


The  muscles  everywhere  are  directly  dependent  upon 
the  brain-and-spine,  not  only  for  power  but  for  growth. 
When  the  electric  bells  of  a  dwelling-house  ring  faintly 
or  cease  to  ring,  and  the  bell-rnan  is  summoned,  he  turns 
his  first  attention,  not  to  the  bell,  but  to  the  batteries 
hidden  away  in  the  attic  or  cellar.  In  paralysis  of 
muscles  it  is,  in  most  cases,  the  nervous  tissue  back  of 
the  muscle  that  has  gone  wrong.  A  strong  nervous 
system  is  the  foundation  of  muscular  agility  and  power. 
The  pugilist  Sullivan  has  probably  no  heavier  or  harder 
muscles  than  thousands  of  other  men,  but  a  superior 
quality  of  nerve  tissue  enables  him  to  use  heavy  muscles 
with  the  rapidity  and  cat-like  agility,  and  the  concen- 
tration of  power  in  a  single  blow,  that  makes  him  so 
effective  as  a  pugilist.  An  irregular,  dissipated  life  would 
soon  ruin  this  fine  quality  and  reduce  him  to  the  level 
of  other  men.  Hanlan,  for  many  years  the  champion 
oarsman  of  the  world,  has  not  very  large  muscles,  but 
his  superior  quality  of  brain  and  spine  tissue  gives  him 
a  high  and  sustained  power  which  few  men  can  equal. 
The  common  gymnastic  feat  of  raising  one's  self  a 
number  of  times  on  the  horizontal  bar  is  one  in  which 
neurasthenics  never  succeed  very  well ;  they  lack  reserve 
power. 

The  relation  of  the  nervous  system  to  the  muscular 
apparatus  is  often  illustrated  in  professional  athletes. 
When  a  man  is  trained  too  fine,  i.  <?.,  when  his  muscles 
are  developed  out  of  proportion  to  the  capacity  of  his 
nervous  system  to  create  and  supply  force,  and  of  his 
heart  and  lungs  to  supply  blood  and  oxygen,  he  lacks  stay- 

4  (49) 


5O  NERVE   WASTE. 

ing  power  and  is  apt  to  be  defeated  in  a  contest.  Readers 
of  Wilkie  Collins'  novel  "  Man  and  Wife  "  will  remember 
the  fate  of  Geoffrey  Delamayne.  Dr.  Winship,  a  one- 
time celebrity  of  Boston,  who  trained  himself  from  a  puny 
college  boy  to  a  Hercules  in  lifting  heavy  weights,  suf- 
fered from  palpitations  and  faintings  during  his  public 
exhibitions.  Many  large  muscled  men  suffer  severely  from 
nervous  symptoms. 

Trembling  of  fingers  and  hands  is  a  common  phase  of 
nervo-muscular  impairment ;  it  may  be  more  or  less  con- 
stant, or  may  only  be  manifested  when  an  unusual  de- 
mand is  made  upon  the  nervous  system,  as  during 
sudden  emotional  excitement,  or  after  any  great  muscu- 
lar effort. 

A  sudden  twitching  or  starting  of  the  muscles  of  one 
limb  or  the  entire  body,  generally  on  going  to  sleep,  and 
a  twitching  of  the  muscles  about  the  eyelids  in  reading 
or  in  any  work  requiring  eye  strain,  are  symptoms  that 
are  frequently  described  by  neurasthenic  patients.  These 
tremblings  and  twitchings  indicate  the  unsteady  inter- 
mittent character  of  the  nerve-current  from  brain-and- 
spine  to  muscle. 

WRITER'S  CRAMP,  or  writer's  palsy,  is  an  example  of 
the  exhaustion  of  certain  groups  of  nerve-cells.  This 
is  one  of  a  family  of  nervous  disorders  known  as  ' '  occu- 
pation neuroses,"  which  is  seen  among  telegraphers, 
musicians,  dancers,  engravers  and  others,  who  habitually 
use  one  set  of  muscles  to  do  more  or  less  fine  work.  The 
individual  partially  or  completely  loses  the  ability  to 
make  the  familiar  movements  of  his  craft,  while  in  other 
respects  the  limb  is  but  little  impaired.  Thus  the  pen- 
man may  become  unable  to  write  or  even  to  grasp  his 
pen,  while  his  ability  to  play  ball  or  row  a  boat,  or  do 
any  coarse  movement,  may  be  as  good  as  ever.  The 
cell  combination  in  the  nervous  system  which  directs  the 
complex  act  is  exhaust  ,d.  The  fact  that  the  symptoms 


of  writer's  cramp  are  chiefly  manifested  in  the  extremi- 
ties leads  many  to  suppose  that  it  is  a  purely  local  affec- 
tion ;  but  if  the  subject  attempts  to  use  the  left  hand  in- 
stead of  the  right  the  disease  soon  appears  there  as  well. 

Cramp  or  palsy  is  only-  one  of  many  symptoms  ex- 
hibited in  the  occupation  neuroses,  and  even  these  may 
be  absent  in  well-defined  cases  of  writer's  cramp.  Three 
types  of  these  disorders  have  been  described,  viz.:  the 
spasmodic,  the  paralytic  and  the  tremulous,  according  as 
cramp,  weakness  or  trembling  is  the  most  marked  symp- 
tom in  the  case.  One  of  the  earliest  and  most  constant 
symptoms  is  a  sense  of  unnatural  fatigue  in  the  hand, 
arm  or  shoulder,  which  may  grow  into  a  dull  aching 
pain  during  work.  Sometimes  this  pain  implicates  the 
whole  limb  from  the  fingers  to  the  spine,  and  is  so  great 
as  to  compel  the  individual  to  cease  work.  Other  symp- 
toms frequently  described  are  stiffness  and  tightness  of 
the  fingers  or  arm  ;  trembling  or  twitching  unsteadiness 
of  the  limb  ;  cramp,  spasm,  or  jerking  or  tightness  of  the 
muscles  ;  soreness  and  tenderness  ;  loss  of  power;  various 
morbid  sensations  in  the  limb,  as  a  sense  of  itching, 
burning,  tingling,  creeping,  prickling,  numbness  on  the 
surface;  binding  about  the  wrist;  feelings  of  heat  or  cold- 
ness; neuralgia;  a  tendency  to  grasp  or  clutch  the  pen 
too  tightly,  and  to  bear  down  heavily  upon  the  desk. 

Victims  of  writer's  cramp  often  suppose  that  they  have 
rheumatism  and  treat  for  this  disease. 

Many  cases  of  writer's  cramp  are  cured  quickly  and  per- 
manently without  abandoning  work.  These  are  gener- 
ally cases  in  which  the  disorder  has  not  become  too  chronic. 
In  some  cases  a  more  or  less  prolonged  vacation  is  nec- 
essary, and  in  certain  old  cases,  especially  existing  in 
thoroughly  broken-down  patients,  no  treatment  will  do 
more  than  lessen  the  evil.  The  treatment  of  this,  as  of 
all  similiar  disorders,  is  a  combination  treatment.  It 
includes  among  other  things: 


52  NERVE    WASTE. 

1.  Change  in  work.     The  patient  must  endeavor  to 
do  his  work  by  means  of  motions  as  opposite  to  those  to 
which  he  has  been  accustomed  as  possible  ;  in  the  style 
of  the  pen  and  holder,  in  holding  the  pen,  in  standing  or 
sitting  at  work,  in  lifting  Heavy  books,  many  changes 
may  be  made  which  will  throw  part  vof  the  strain  of  work 
upon  other  nerve-cells  and  rest  those  which  have  been 
over-drawn. 

2.  Training.     When  an  athlete  wishes  to  get  himself 
into  the  best  possible  condition,  he  goes  into  training  for 
a  time.     So  the  victim  of  writer's  cramp  who  wishes  to 
hold  his  position  must  often  reform  his  habits  of  eating, 
drinking,  smoking,   sleeping,   and  perhaps  deny  himself 
many  things  in  which  he  takes  comfort. 

3.  Klectricity  in  the  form  of  local  and  central  galvan- 
ism i.3  the  most  efficacious  single  remedy.     It  generally 
relieves  pain  at  once  and  substitutes  a  grateful  glow  for 
the  feeling  of  fatigue  and  stiffness  so  often  complained  of. 
Its  permanent  effect  is  equally  valuable  and  I  have  never 
seen  a  case  of  writer's  cramp  that   was   not   distinctly 
benefited  by  this  remedy. 

4.  Massage.     Kneading  and  various  passive  exercises 
of  the  affected  muscles  are  useful  measures,  as  is  also  hot 
bathing. 

5.  Hypodermic  injections  of  various  medicines  into  the 
affected  limb  are,  next  to  electricity,  the  most  potent  meas- 
ure, though  not  adapted  to  all  cases. 


MUSCULAR   SIGNS THE    CONVULSIVE    DISORDERS 

• 

Convulsion  and  spasm  are  italicized  signs  that  some- 
thing is  wrong  with  the  brain-and-spine.  In  many  cases 
of  convulsive  disease  search  discovers  a  cause  therefor  in 
some  irritation  of  the  gray  brain-cortex,  whether  existing 
in  the  brain  itself  or  transmitted  thither  from  without  by 
sensory  nerves.  But  in  other  cases  no  cause  can  be  dis- 
covered; if  death  occurs  from  accident,  necropsy  shows  no 
morbid  change,  and  the  microscopist  with  ever  so  high  a 
power  can  detect  nothing  abnormal  in  the  nervous  struc- 
tures. An  unstable,  a  weakened,  an  over-sensitive,  or  all 
three  of  these  conditions  of  the  brain-and-spine,  may  man- 
ifest itself  in  convulsive  muscular  movements  of  various 
kinds.  Chorea,  Hysteria,  and  Epilepsy  can  hardly  even 
be  alluded  to  in  the  few  pages  that  can  be  spared  here, 
but  a  few  facts  may  serve  as  introduction  to  a  statement 
of  the  important  principles  of  treatment  which  apply  to 
all  three. 

IN  ST.  VITUS'  DANCE,  irregular  and  more  or  less  violent 
convulsions,  involving  single  muscles  or  groups  of  mus- 
cles, which  are  exaggerations  of  natural  movements  rather 
than  convulsions,  occur;  the  term  ' '  insanity  of  the  mus- 
cles," has  been  applied  to  it.  In  the  fourteenth  and  fif- 
teenth centuries  an  endemic  nervous  disorder  prevailed  in 
the  region  of  the  Rhine  and  the  Moselle,  and  it  was  cus- 
tomary to  lead  victims  to  the  chapel  of  St  Vitus  at  Stras- 
burg,  where  they  were  supposed  to  be  cured  by  religious 
ceremonies  and  invocations.  The  various  forms  of  chorea 
which  are  now  popularly  known  as  St.  Vitus'  dance  have 
no  similarity  to  the  nervous  epidemics  of  the  middle  ages. 

(53) 


54  NERVE    WASTE. 

Chorea  has  been  traced  to  various  physical  changes  in  the 
brain,  and  to  various  irritations,  poisonous  or  reflex.  The 
chorea  of  nervous  impairment  is  apt  to  develop  in  children, 
more  often  in  girls,  between  the  ages  of  seven  and  fifteen. 
Habit  and  imitation  sometimes  develop  and  establish  this 
disorder.  Chorea  is  the  most  easily  .curable  of  the  con- 
vulsive disorders,  though  it  occasionally  runs  a  course  of 
a  year  or  more,  and  may  become  chronic. 

HYSTERIA  is  the  most  protean  of  all  diseases;  convul- 
sive seizures  are  but  one  phase  of  it,  and  they  are 
sometimes  absent.  The  entire  apparatus  of  perception 
may  be  deranged;  morbid  sensations,  aches,  and  pains, 
which  are  true  cerebral  hallucinations,  are  complained  of. 

The  motor  apparatus  may  be  periodically  agitated  by 
convulsive  movements,  or  may  remain  paralyzed  in  one 
limb  or  another  for  five,  ten,  or  even  twenty  years,  to  be 
miraculously  cured  in  a  week  or  a  moment  by  the  faith 
cure,  or  a  bottle  of  the  water  of  gourdes.  The  mind  often 
distinctly  deteriorates  in  its  moral  element;  hysterical 
patients  are  sometimes  mendacious,  deceitful,  egotistic, 
selfish,  and  painfully  lacking  in  moral  stability.  Some  of 
the  most  remarkable  instances  might  be  related  of  the 
deep-laid  and  ingenious  tricks  which  have  been  resorted 
to  by  hysterical  patients  to  obtain  the  notoriety  or  the 
attention  they  crave. 

The  fact  that  typical  hysteria  is  almost  confined  to  the 
female  long  led  to  the  supposition  that  it  has  its  origin  in 
the  womb,  but  hysteria  is  occasionally  observed  in  the 
male,  and  the  exaggerated  emotional  susceptibility  pe- 
culiar to  this  disorder  is  not  so  very  rare  in  man.  Hysteria 
varies  in  type  in  different  countries  and  at  different  ages. 
France  develops  a  type  of  hysteria,  hystero-epilepsy  or 
hysteria  major  of  Charcot,  that  is  seldom  seen  in  England 
or  America.  Hysteria  mimics  all  diseases;  hysterical  in- 
sanity, hysterical  unconsciousness,  hysterical  amblyopia, 
deafness,  paralysis,  convulsions,  pain,  asthma,  dyspepsia, 


MUSCULAR    SIGNS THE    CONVULSIVE    DISORDERS.         55 

joint-disease,  ovarian  and  uterine  disease,  and  even  hys- 
terical pseudo-pregnancy  occur. 

EPILEPSY,  "the  falling  sickness,"  is  a  very  ancient 
disease.  In  ancient  times  one  having  it  was  supposed  to 
be  "possessed  of  a  devil,"  and  religious  formulas  were 
resorted  to  to  drive  out  the  unclean  spirit.  The  essential 
features  of  epilepsy  are  sudden  loss  of  consciousness  and 
convulsions,  but  many  subtle  and  masked  phases  of  this 
disorder  have  been  noted.  In  severity  an  attack  varies 
all  the  way  from  slight,  almost  imperceptible,  uncon- 
sciousness to  tragic  fits,  and  even  to  violent  homicidal 
mania.  Epilepsy  is  most  common  between  the  ages  of 
ten  and  twenty — puberty  is  a  comparatively  unstable 
period  of  life — but  may  occur  at  any  age.  The  frequency 
of  attack  varies  from  once  in  one  or  two  years  to  even  one 
hundred  and  fifty  seizures  in  twenty-four  hours;  the 
larger  proportion  of  cases  outside  the  asylums  have  well- 
defined  attacks  once  in  two  or  three  weeks.  The  two 
factors  in  this  disease  are  intrinsic  instability  (hereditary 
or  acquired)  of  the  higher  brain-cells  plus  an  irritation. 
The  irritating  impression  may  consist  in  blood-fullness, 
in  a  blood-poison,  or  may  be  reflected  from  a  distance. 
Recent  observations  render  it  probable  that  ocular  defects 
are  a  frequent  irritating  cause,  among  others.  Habit  has 
much  to  do  with  the  development  and  maintenance  of 
epilepsy.  Each  fit  renders  subsequent  ones  more  probable 
and  more  easy.  Thus  the  reflex  convulsions  of  childhood 
sometimes  merge  into  epilepsy,  and  thus  in  the  adult,  fits 
which  are  only  epileptiform  may  gradually  become  epilep- 
tic. The  tendency  of  this  disorder  is  to  weaken  body  and 
mind,  although  it  does  not  always  do  so.  It  is  probable 
that  the  epileptic  seizure  is  a  sign  of  various  conditions 
which  we  are  unable  to  differentiate  in  the  present  state 
of  our  knowledge.  Thus  the  epileptic  fits  of  Napoleon 
did  not  express  the  same  condition  of  brain  deficiency 
that  those  of  the  idiot  epileptics  of  our  asylums  do.  In- 


56  NERVE    WASTE. 

stability  is  the  prominent  defect  of  the  one,  abject  weak- 
ness of  the  other. 

The  curative  treatment  of  the  convulsive  disorders  in- 
cludes three  great  principles: 

1.  Elimination.     The  search  for  and  removal  of  out- 
lying irritations,  which  may  be  acting  backward  to  irritate 
and  depress  the  brain,  is  of  the  first  importance;  in  an  ob- 
scure case  every  organ  and  cavity  of  the  body  may  have 
to  be  interrogated. 

2.  Brain-and-spine  peace — rest.    This  may  require  re- 
moval of  a  precocious  child  from  school,  or  in  adults  a 
change  of  occupation  or  of  environment.     Sleep,  quiet, 
uneventful,   unirritating  surroundings  are  desirable   in 
every  case;  in  children,  a  year  of  "quiet  country  life  and 
sunshine,  away  from  city  sights  and  sounds,  will  succeed 
where  the  great  city  specialist  in  nervous  diseases  will 
fail.     In  a  few  cases  the  principle  of  securing  absolute 
peace  for  the  central  nervous  system  must  be  carried  to 
the  length  of  secluding  a  patient  in  a  darkened  room  for 
weeks,  shutting  out  even  the  stimuli  of  light  and  sound; 
the  oculist  can  testify  to  the  value  of  this  procedure  in 
his  department  of  nervous  disorder. 

3.  Brain-and-spine  nutrition — building.  Food  and 
oxygen  are  the  material;  electricity,  counter-irritation, 
heat,  cold  and  drugs,  are  the  forces;  as  with  all  the  forces 
which  man  converts  to  his  uses,  these  act  beneficently  in 
proportion  as  they  are  guided  wisely. 

There  is  no  magical  cure  for  most  cases  of  convulsive 
nervous  disease.  It  is  a  matter  of  earnest,  faithful  per- 
sistent adherence  to  the  principles  which  physiology  and 
experience  alike  teach  us.  It  is  a  careful,  continuous, 
vigilant,  never-relaxing  care  and  attention  to  numerous 
details.  I  am  convinced  that  many  uncured  cases  of  con- 
vulsive nervous  disease  are  so  because  treatment  has 
never  gone  deep  enough  nor  far  enough,  and  has  not  been 
characterized  by  the  extreme  thoroughness  which  is  es- 


MUSCULAR    SIGNS THE    CONVULSIVE    DISORDERS.         57 

sential  to  success.  We  have  many  other  and  more  pow- 
erful forces  than  drugs  which  act  upon  the  human  tissues, 
and  the  cure  of  these  disorders  is  a  matter  of  wider  scope 
than  the  prescription  of  bromides  or  of  phosphorus.  It  is 
a  pathetic  fact  that  the  enthusiasm,  the  pluck,  the  faith- 
fulness, the  wisdom,  which  is  more  than  sufficient  to  cure 
nervous  disease  is  often  lacking  in  parents,  and  that  the 
medical  man  sometimes  finds  his  feebly-aided  efforts  in- 
sufficient to  rescue  a  child  from  a  future  which  is,  in  some 
cases,  worse  than  death.  In  these  disorders,  if  the  neces- 
sary care  is  great  and  the  details  tedious,  the  end  for 
which  we  strive  is  great,  and  even  the  prospect  of  success 
justifies  great  effort. 


XI 

RESPIRATORY    SIGNS HAY    FEVER    AND    ASTHMA 

The  respiratory  apparatus,  so  far  as  hay  fever  and 
asthma  are  concerned,  may  be  described  as  consisting  of 
first,  the  mucous  lining  of  the  nose,  throat,  voice-box, 
windpipe,  and  lungs;  second,  the  nerves,  nerve-ends,  in- 
going sensation-bearing  nerve-fibers,  out- coming  impulse- 
bearing  fibers  and  vaso-motor  (blood-current  regulating) 
fibers;  third,  the  respiratory  nerve-centers  in  the  medulla, 
(between  brain  and  spine) ;  fourth,  the  unstriped  muscular 
fiber  which  constitutes  the  middle  wall  of  bronchial  tube, 
wind-pipe,  and  of  artery  and  vein  everywhere. 

HAY  FEVER  is  a  curious  disorder  in  many  respects.  It 
attacks  almost  exclusively  the  sedentary,  brain-working, 
well-to-do  population  or  their  descendants.  It  recurs 
annually  with  singular  exactness;  some  persons  are  at- 
tacked at  the  same  hour  of  the  same  day  each  year.  It 
amounts,  in  some  cases,  to  no  more  than  a  bad  cold  in  the 
head;  in  other  cases  the  coryza  is  followed  by  bronchitis, 
cough,  and  asthmatic  seizure  of  the  most  intense  descrip- 
tion. These  asthmatic  attacks  are  the  most  dreaded 
feature  of  hay  fever,  and  sometimes  prolong  the  attack 
for  weeks  or  months,  though  the  usual  duration  of  an  at- 
tack is  about  a  month.  The  law  of  habit  has  consider- 
able to  do  with  this,  as  with  all  functional  nervous  dis- 
orders; each  attack  favors  a  recurrence. 

The  nature  of  hay  fever  has  been  the  subject  of  much 
discussion.  It  has  been  called  a  purely  local  (nasal  and 
bronchial)  disorder,  a  purely  nervous  (vaso-motor)  disor- 
der, and  a  purely  toxic  (pollen-poisoning)  disorder.  The 

(58) 


RESPIRATORY    SIGNS HAY   FEVER   AND   ASTHMA          59 

prevailing  theory  now  is  that  hay  fever  is  a  respiratory 
neurosis,  in  which  irritated  nerve-ends,  over-sensitive 
respiratory  nerve-centres,  unstable  respiratory  vaso-motor 
innervation  act  in  different  proportion  in  each  case. 

NEUROTIC  ASTHMA  is  that  variety  of  spasmodic  difficult 
breathing  which  cannot  be  traced  to  any  physical  cause. 
In  many  cases  there  is  no  bronchitis  nor  heart,  stomach, 
kidney  or  skin  disease  nor  blood  poison  to  explain  the 
paroxysm,  and  we  can  only  suppose  over-sensibility  of 
nerve-end  and  nerve-centre  to  irritants  which  are  often 
trivial,  and  which  are  not  noticed  by  ordinary  persons. 
Asthma  and  epilepsy  occur  in  the  same  individual  with 
sufficient  frequency  to  suggest  a  kind  of  relationship  be- 
tween them.  Eczema  and  other  skin  diseases  involving 
imperfect  secretion  through  the  skin,  and  thus  blood 
poisoning,  is  a  somewhat  common  accompaniment  of 
neurotic  asthma.  Asthma,  epilepsy  and  eczema  have 
occurred  together  in  several  persons  who  have  come 
within  my  observation.  A  paroxysm  of  asthma  lasts  from 
half  an  hour  to  several  days  and  tends  to  recur  at  more 
or  less  frequent  intervals.  Chronic  asthma  is  capable  of 
inducing  certain  physical  changes  in  the  structure  of  the 
lungs  and  heart — emphysema,  dilatation  of  the  pulmonary 
vessels  and  of  the  right  side  of  the  heart. 

THE  TREATMENT  of  hay  fever  and  that  of  neurotic  asthma 
are  similar:  it  includes  preventive  palliative  and  curative 
measures. 

Change  of  climate  is  the  best  means  of  avoiding  an 
attack  of  hay  fever,  and  is  often  the  best  in  asthma.  For 
hay  fever  the  White  Mountains,  several  sea  islands,  and 
at  sea,  out  of  sight  of  land,  are  famous  asylums.  The  long, 
dry  summer  season  of  California,  in  which  flowers  and 
pollens  play  but  little  part,  is  favorable  to  both  hay  fever 
sufferers  and  asthmatics.  The  tonic  influence  of  change 
and  rest  probably  have  something  to  do  in  this  means  of 
warding  off  an  attack. 


60  NERVE    WASTE. 

The  palliative  treatment  of  both  hay  fever  and  asthma 
utilizes  every  stimulant  and  sedative  on  the  list  and  then 
sometimes  fails.  Of  stimulants  caffeine,  strong  coffee, 
acholic  liquors,  Indian  hemp  and  nux  vomica  are  the  most 
common  in  use.  Of  sedatives,  belladonna,  hyoscyamus, 
stramonium,  duboisia, Hoffman's  anodyne,  grindelia, nitrite 
of  amyl  inhalations,  eucalyptus,  and  the  nauseants  tobacco, 
lobelia  and  ipecac  succeed  and  fail.  Morphine,  ether  and 
chloroform  will  give  temporary  relief.  Solutions  of 
cocaine  locally  applied  have  a  power  of  reducing  engorge- 
ment in  mucous  membrane,  which  is  of  great  use  in  the 
beginning  of  hay  fever. 

Various  inhalations  afford  relief  in  asthma,  that  of 
oxygen,  the  smoke  of  stramonium  leaves  and  of  saltpetre. 
The  most  efficacious  smoke  is  that  from  powdered  lobelia, 
powdered  stramonium  leaves,  powdered  saltpetre,  and  pow- 
dered black  tea,  of  each  two  ounces,  mixed,  sifted,  burned, 
or  smoked,  and  the  smoke  inhaled.  Powerfully  impress- 
ing and  diverting  the  blood-current  from  the  nervous  cen- 
tres is  a  principle  which  acts  well  in  many  cases;  the  hot 
mustard  foot-bath,  a  mustard  plaster  or  dry  cupping 
between  the  shoulders,  ice  bags  to  the  base  of  the  brain, 
to  the  back  of  the  neck,  and  to  the  spine  are  all  made  to 
accomplish  this  indication. 

Galvanism  of  the  pneumogastnc  nerve,  and  of  the 
neck  greatly  modify  the  paroxysm  of  asthma. 

The  curative  treatment  of  the  respiratory  neuroses  is 
sometimes  surgical,  and  always  hygienic.  Surgery,  in 
the  form  of  the  galvano-cautery,  the  snare,  the  knife  or 
caustics  is  sometimes  successful  when  there  is  obvious 
local  disease  within  the  nasal  passages.  The  cure  and 
the  treatment  against  hay  fever  and  neurotic  asthma 
involves  the  whole  subject  of  nervous  hygiene.  Cod  liver 
oil  and  arsenic  are  the  great  remedies.  The  most  effica- 
cious treatment  against  the  respiratory  neuroses  would  be- 
gin two  or  three  generations  before  the  individual  is  born. 


XII 


ABDOMINAL    SIGNS,    NERVOUS    INDIGESTION. 

Before  food  can  become  blood  it  must  go  through  sev- 
eral processes  : 

1.  Prehension,  or  the  act  of  getting  it  into  the  mouth. 

2.  Mastication,  or  chewing. 

3.  Deglutition,  or  swallowing. 

4.  Digestion,  or  the  reduction  of  food  to  a  liquid,  and 
the  conversion  of  it  into  chyle. 

5.  Absorption  of  this  digested  food-stream  from  stom- 
ach and  intestines. 

6.  Liver  action  upon  albumens,  starches  and  sugars. 
The   abdominal   organs   do   not  maintain    their   tone, 

secrete  their  juices  and  nourish  themselves  by  their  own 
inherent  vitality,  but  they  are  enabled  to  do  these  things 
because  they  are  innervated,  vitalized  or  supplied  with 
nerve- force  by  the  brain  and  spine  through  the  sympa- 
thetic nervous  system. 

That  portion  of  the  sympathetic  system  which  di- 
rectly supplies  the  vital  (breathing,  circulating,  digest- 
ing) organs  with  power,  is  placed  for  protection  and 
convenience  in  the  great  cavities  of  the  chest  and  abdo- 
men. Here  the  sympathetic  centres  with  their  con- 
necting nerves  form  a  double  chain  in  front  of  the  spine, 
extending  from  the  neck  to  the  pelvis.  This  outlying 
dependency  of  the  brain  and  spine  is  independent  of  the 
will,  is  011  duty  day  and  night ;  its  nerve-cells  are  kept 
charged  with  nerve  force  by  the  central  nervous  system, 
and  act  as  reservoirs  of  vitality  for  the  internal  organs. 

POOR  APPETITE  AND  INDIGESTION.  —  The  digestive 
juices — which  attack  the  food,  soften  it  and  change  it 

(61) 


62  NERVE    WASTE. 

chemically  so  as  to  reilder  it  fit  for  absorption — are 
secreted  by  innumerable  follicles  in  and  adjacent  to 
stomach  and  bowels.  These  follicles  depend  directly  for 
their  power  of  secreting  upon  the  nervous  system.  This 
excito-secretory  function  of  the  nervous  system  is  pow- 
erfully affected  by  mental  influence.  When  any  intense 
emotion,  as  terror  or  anger,  or  any  great  excitement, 
rapidly  uses  up  a  great  amount  of  nerve-force  the  diges- 
tive secretions  may  be  almost  suspended  for  hours,  or 
even  for  days.  So,  when  the  brain  or  the  muscles  are 
over-worked  the  nervous  allowance  of  the  great  sympa- 
thetic system  is  reduced,  and  the  quantity  and  quality  of 
the  digestive  juices  suffers  from  this  impoverishment. 
After  a  day  of  severe  toil  a  man  may  feel  ' '  too  tired  to 
eat,"  which  means  that  the  nervous  system  has  been 
overtaxed,  and  the  stomach  lining,  lacking  its  accus- 
tomed stimulus,  does  not  secrete  its  juices — feels  no  appe- 
tite. 

ATONY  IN  STOMACH  AND  BOWEL  WALLS. — Of  the  three 
coats  or  layers  which  make  up  the  stomach  and  bowel 
walls,  the  middle  one  is  composed  of  contractile  muscu- 
lar fibres,  and,  by  the  elasticity  and  resiliency  of  these 
muscular  fibres,  the  shape  and  tone  of  these  organs  is 
maintained.  As  has  been  explained,  this  muscular  tone 
depends  directly  upon  a  steady  supply  of  nerve  force 
from  the  cells  of  the  sympathetic  nervous  system.  When 
the  force-creating  and  force-supplying  capacity  of  these 
cells  is  impaired,  the  muscular  coat  of  the  stomach  loses 
tone,  becomes  more  or  less  relaxed,  the  gases  of  slow 
digestion  distend  it,  the  subject  describes  his  stomach  as 
"  bloating." 

A  French  physician,  M.  Glenard,  has  lately  described 
a  peculiar  condition  which  I  have  noted.  He  gives  it 
the  name  Enteroptose,  which  means  a  "  falling  of  the 
bowels. ' '  In  this  condition  the  contents  of  the  abdomen 
are  not  firmly  supported,  but  drag  upon  their  ligaments. 


ABDOMINAL    SIGNS,    NERVOUS    INDIGESTION.  63 

The  changed  position  of  the  parts  which  thus  results 
gives  rise  to  changes  in  the  calibre  of  both  stomach  and 
intestines — dilatations  and  constrictions  occur  at  various 
points,  which  interfere  with  the  proper  performance  of  the 
digestive  function. 

This  condition  may  affect  the  entire  abdominal  mass, 
but  M.  Glenard  reports  that  the  most  frequent  form  of 
enteroptosis  is  a  displacement  or  falling  of  the  right  arch 
of  the  large  intestine.  This  arch  normally  lies  at  a 
point  in  the  abdomen  just  to  the  right  and  a  little  above 
the  navel,  and  helps  to  support  the  stomach  above,  and 
when  it  becomes  prolapsed  the  stomach  in  its  turn,  sinks, 
drags  and  is  weakened. 

Gastro-ectasis,  or  bloating  and  prolapse  of  the  abdo- 
minal mass,  sometimes  occur  in  the  same  subject. 

DIGESTIVE  BREAKDOWNS. — In  some  over-worked  men 
the  digestion  remains  pretty  good,  but  is  liable  to  sud- 
den break-downs.  On  certain  days  without  any  appar- 
ent cause  the  subject  finds  that  his  dinner  rests  like  a  bar 
of  lead  upon  his  stomach;  or  sour  risings,  heartburn  and 
belchings  indicate  plainly  enough  that  the  meal  is  being 
slowly  and  imperfectly  digested.  Or,  after  a  hard  day's 
work,  or  after  some  trifling  indigestion  in  eating,  the 
individual  may  be  attacked  by  violent  colic  or  cramps, 
with  nervous  chills,  which  in  some  cases  prostrate  and 
incapacitate  him  for  several  days. 

Such  attacks  may  occasionally  be  traced  to  pieces  of  undi- 
gested food  no  larger  than  the  little  finger  nail.  At  such 
a  time  a  piece  of  cheese,  of  preserved  fruit,  or  of  walnut 
may  be  too  tough  for  the  deteriorated  gastric  and  intesti- 
nal juices.  Again,  the  intestinal  gases,  which  are  always 
present  in  larger  quantities  during  and  after  slow  diges- 
tion, accumulate  in  the  bowel,  the  tired  relaxed  bowel- 
wall  has  not  the  tone  to  contract  upon  them,  move  them 
along  and  properly  distribute  them  in  the  intestine,  and 
colic  results.  In  other  cases  the  irritable  and  weakened 


64  NERVE    WASTE. 

nerves  of  the  abdomen  become  the  seat  of  paroxysms  of 
pain  and  of  a  variety  of  unnatural  sensations,  which  are 
independent  of  any  exciting  cause  that  can  be  discovered. 
Soreness,  dragging,  fluttering,  burning,  or  a  feeling  of 
weakness  are  among  the  sensations  described  by  different 
patients.  These  and  other  sensations  are  frequently  lo- 
cated somewhere  about  the  navel. 

THE  LIVER  TYPE  OF  NERVOUS  INDIGESTION. — Many 
years  ago  it  was  first  noted  that  in  certain  cases  of  dys- 
pepsia, torpid  liver,  as  well  as  in  cases  of  nervous  strain 
or  over-work,  the  urine  is  scant,  high  colored,  of  a  high 
specific  gravity  and  deposits  certain  substances  on  cool- 
ing. Of  these,  uric  acid  crystals,  urates  of  soda  and  other 
urates  — forming  a  reddish  brick-dust  deposit,  which  clings 
tenaciously  to  the  sides  of  the  vessel,  oxalate  of  lime — 
whitish,  thick  and  often  very  abundant — one  or  all 
together  are  found  in  different  urines.  The  relation 
between  oxaluria  (oxalic  acid  or  oxalate  of  lime  in  the 
urine),  lithsemia  (lithic  acid  in  the  blood),  and  lithiasis 
(the  lithic  acid  diathesis  or  tendency)  to  nervous  impair- 
ment is  now  well  understood. 

The  liver  weighs  from  three  to  four  pounds,  and  is  one  of 
the  most  complex  and  important  organs  in  the  body. 
One  of  its  functions  is  to  stand  between  the  blood-stream 
of  the  digestive  organs  and  that  of  the  rest  of  the  body. 
At  the  gates  of  the  portal  or  abdominal  circulation,  it 
exercises  a  prudent  discrimination,  as  St.  Peter  is  reputed 
to  do  at  the  gates  of  heaven,  and  only  admits  such  and 
so  much  of  the  often  impure  or  gross  stream,  which  results 
from  digestion,  as  is  good.  It  would  not  do  to  allow 
all  that  every  man  eats  to  get  into  his  general  circulation. 
A  gross  surplusage  must  be  gotten  rid  of,  and  this  is  part 
of  the  work  known  in  physiology  as  excretion.  When 
the  heavy  nitrogenous  elements  of  the  portal  circulation 
representing  meat,  eggs,  the  caseine  of  milk  and  other 
heavy  foods,  are  brought  to  the  liver,  it  admits  some  and. 


ABDQMINAL    SIGNS,    NERVOUS   INDIGESTION.  65 

in  hearty  feeders,  it  restrains  some.  That  which  is  kept 
back  is  subjected  to  the  action  of  oxygen,  oxidized,  disin- 
tegrated or  split  up  into  urea,  carbonic  acid  and  water 
and  borne  to  the  kidneys,  which  filter  it  from  the  blood. 

When  the  liver  is  imperfectly  innervated  or  vitalized  by 
the  sympathetic  nervous  system  it  become  "insufficient." 
It  is  unable  to  do  its  work  thoroughly.  It  fails  to  form 
urea,  and  forms  lithic  or  uric  acid.  Urea  is  soluble  in 
water  and  gives  a  clear  urine;  the  substances  substituted 
for  urea  by  a  tired  liver,  uric  acid,  its  resulting  salts,  the 
urates,  and  its  later  products,  oxalic  acid  and  the  oxalates, 
are  not  very  soluble  in  cold  water  and  so  form  a  variety 
of  urinary  deposits.  Thus  "the  neurotic  with  lithiasis" 
(Fothergill)  is  apt  to  pass  turbid  urine,  or  urine  which  be- 
comes turbid  on  cooling;  to  notice  that  the  bottom  and 
sides  of  the  vessel  are  sometimes  stained  with  a  brick-dust 
deposit;  to  be  troubled  with  "biliousness"  and  constipation, 
and  to  find  that  he  cannot  digest  fats  easily. 

THE  TREATMENT  OF  ABDOMINAL  NEURASTHENIA. — 
When  this  form  of  nervous  impairment  develops  in  one 
who  is  not  used  to  sickness,  much  precious  time  may  be 
lost  before  the  stern  laws  which  pertain  to  it  are  realized, 
and  the  troublesome  regime,  which  experience  has  found 
essential,  is  submitted  to.  Often  this  disease  is  consid- 
ered to  be,  and  treated  as,  dyspepsia,  but  purely  local 
treatment  is  unavailing.  Drugs  alone  have  no  permanent 
power  in  this  disorder.  Merely  local  treatment  is  trim- 
ming at  the  branches,  and  leaving  the  roots  untouched. 
Sometimes  it  is  only  after  ignoring  or  resisting  the  dis- 
ease for  months  or  years,  and  after  trying  every  patent 
medicine,  pathy,  and  marvellous  cure,  that  the  victim 
mellows  into  a  wise  and  painstaking  patient.  Then  the 
true  cure  begins.  General  nervous  hygiene  is  the  founda- 
tion; a  careful  adaptation  of  diet  in  each  case  imperative, 
and  then  drugs  and  electricity  can  help.  A  system  of 
partial  or  complete  liquid  feeding  has  done  me  good 


66  NERVE   WASTE. 

service.  The  diet  in  abdominal  neurasthenia  needs  to 
be  generous,  and  as  soon  as  we  can  get  our  nervous  dys- 
peptic a  little  out-of-doors  it  can  usually  be  made  so,  to  a 
greater  or  less  extent.  The  English  physician  puts  his 
gouty  dyspeptic  and  lithaemic  patients  on  a  reduced  diet 
and  gets  them  well.  The  American  practitioner  finds 
that  his  nervous  lithsemics  do  best  on  a  diet  rich  in  nitro- 
genized  matter  and  fats — on  beef,  eggs,  butter,  cream  and 
wine.  In  abdominal  neurasthenia  the  man  is  not  dyspep- 
tic or  bilious  because  he  eats  indigestible  food  so  much  as 
because  his  digestive  organs  do  not  regularly  receive  their 
nervous  remittances.  Behind  the  unreliable  stomach  or 
the  insufficient  liver  is  the  insufficient  brain  and  spine; 
we  are  curing  a  nervous  system  rather  than  a  liver. 

In  some  cases  we  have  to  face  two  hostile  facts.  First, 
nitrogenized  foods  and  fats  are  essential  to  create  stability, 
endurance,  staying  power  in  the  nervous  structures;  sec- 
ond, the  individual  is  unable  to  digest  these  substances. 
He  is  unable  to  liquefy  and  emulsify  them  into  absorbable 
chyle,  in  stomach  and  intestine  (primary  digestion),  or,  if 
able  to  do  this,  is  unable  to  elaborate  the  food- stream  in 
the  liver,  through  which  digested  meat,  eggs,  milk-casein, 
and  similar  foods  must  pass  before  they  can  become  blood 
(secondary  digestion).  But  the  greater  the  difficulty  the 
greater  the  opportunity  of  the  physician  to  show  whether 
he  is  any  more  clever  at  curing  than  other  people.  By  a 
system  of  food  selection,  cooking,  masticating,  vigilance 
in  avoiding  the  beginnings  of  evil  and  a  knowledge  of 
certain  timely  precautions  we  can  generally  manage. 
The  pedagogic  or  supervising  function  of  the  physician  is 
perhaps  more  important  in  nervous  indigestion  than  in 
any  other  form  of  nervous  impairment. 


XIII 

RECTAL    SIGNS CHRONIC    CONSTIPATION 

Chronic  constipation  is  not  always  a  sign  of  nervous 
impairment,  but  only  very  often.  Then  it  depends  upon 
deficient  moisture  in  the  motions  (deficient  intestinal 
secretion)  or  upon  debility  (poor  innervation)  of  the  un- 
striped  muscular  fibre,  which  constitutes  the  middle  wall 
of  the  lower  bowel.  Constipation  is  both  an  effect  and  a 
cause  of  disease.  Sir  Andrew  Clark  has  recently  applied 
the  term  '  *  fecal  anaemia' '  to  a  class  of  cases,  in  which  the 
elements  of  disease  are  retained  accumulation  in  the  lower 
bowel,  chemical  decomposition  with  formation  of  poison- 
ous matters,  absorption  into  the  blood  and  chronic  blood- 
poisoning.  All  pelvic  and  reproductive  morbid  conditions 
are  especially  aggravated  by  chronic  constipation. 

The  hygiene  of  the  lower  bowel — proper  food,  a  regu- 
lar habit  of  going  to  the  closet  among  other  things — is 
the  best  treatment  of  constipation.  Of  foods  those  which 
afford  a  comparatively  large  remainder  of  waste  to  stimulate 
the  lower  bowel — rolled  oats,  rolled  pearled  wheat,  Indian 
meal — may  be  taken  when  they  agree  with  the  stomach. 
Ripe  fruits  in  summer,  stewed  prunes,  baked  apples,  figs, 
cranberries,  in  winter,  are  valuable.  But  sometimes  med- 
icines are  temporarily  useful.  The  salines  unload  the 
bowels  with  less  disturbance  than  any  other  class  of  drugs. 
Seidlitz  powders,  Rochelle  salts  in  soda-water,  or  any  of 
the  popular  mineral  waters  may  be  occasionally  relied 
upon.  A  very  convenient  and  portable  preparation  is 
"Tarrant's  seltzer  aperient,"  of  which  one  or  two  tea- 
spoonfuls  in  a  glass  of  cold  or  warm  water  before  break- 
fast will  be  sufficient.  A  regular  glass  of  simple  water 
on  rising  is  sufficient  to  regulate  some  persons.  The 

(67) 


68  NERVE    WASTE. 

habit  of  tippling  mineral  waters,  and  especially  hot  water, 
is  to  be  condemned  for  reasons  which  there  is  not  space 
to  explain. 

A  very  good  pill  against  neurasthenic  constipation — 
for  temporary  use,  is  the  following. 

Take  Extract  of  Nux  Vomica 8  grains 

Extract  of  Belladonna 4  grains 

Resin  of  Podophyllum 4  grains 

Oleo-resin  of  Capsicum 2  drops 

Aloin 8  grains 

Powdered  Ipecac 2  grains 

Extract  of  Dandelion  to  make...  64  grains 
Mix ;  divide  into  thirty-two  pills.  Dose  one  to  three  at  bed-time 

till  the  desired  effect  is  produced;  then  continue  with  one-half  or 

one-quarter  of  a  pill  at  bed-time  for  a  week. 

It  often  happens  that  the  lower  bowel  is  the  only  point 
at  fault  in  chronic  constipation,  and  then  it  may  be  best 
not  to  use  any  medicine  at  all.  Any  drug  that  influences 
the  lower  bowel  must  also  stimulate,  to  some  extent,  in 
passing  through,  the  whole  intestinal  tract,  which  is  not 
always  desirable.  In  such  a  case  a  daily  injection  of  a  half- 
pint  of  cold  water  into  the  lower  bowel  will  accomplish 
all  that  drugs  can,  and  will  have  a  tonic  effect  beside. 
In  sexual  neurasthenia  this  is  the  best  method;  the  deep 
urethra  and  the  prostate  are  in  close  anatomical  rela- 
tion to  the  lower  bowel,  and  it  makes  a  great  difference 
in  these  organs  whether  the  rectum  is  clogged  and  heated, 
or  whether  it  is  clean,  cool  and  unirritated.  Mild  galvan- 
ization of  the  spine,  the  abdominal  sympathetic  and  of  the 
rectum  itself  will  sometimes  cure  obstinate  constipation 
when  all  else  has  failed. 


XIV 

HEPRODUCTIVE  SIGNS — SEXUAL    NEURASTHENIA  IN  THE 

MALE 

An  apparatus  in  physiology  is  a  collection  of  organs 
charged  with  the  performance  of  a  particular  function. 
Thus  we  speak  of  the  visual,  vocal,  respiratory  and 
digestive  apparatus.  The  reproductive  apparatus,  viewed 
thus  comprehensively,  includes  not  only  the  external 
organs  of  generation,  but  also  certain  portions  of  the 
spinal  cord  and  brain,  without  which  there  can  be  no 
reproductive  activity.  The  spinal  cord  and  sympathetic 
are  reproductive  organs  as  far  as  they  contain  erigerent, 
trophic  and  excito-secretory  nerve-centres.  The  brain  is 
a  reproductive  organ  as  far  as  certain  of  its  cortical  cells 
inherit  erotic  instincts,  and  receive,  react  to  and  remem- 
ber erotic  impressions. 

REPRODUCTIVE  SIGNS  OF  GENERAL  NERVOUS  IMPOVER- 
ISHMENT.— When  the  sum  total  of  the  nervous  resources 
is  reduced,  the  reproductive  apparatus  is  very  apt  to 
manifest  weakness  or  unsteadiness.  Seminal  secretion 
may  be  scant  or  may  fail  altogether,  and  the  individual 
may  remain  without  sexual  desire  for  months  or  years. 
Krection  may  be  feeble  and  poorly  sustained,  and  prema- 
ture and  feeble  emission,  on  attempting  coitus,  is  a  com- 
mon symptom  of  the  nervous  irritability  and  weakness  of 
this  type  of  neurasthenia.  In  some  cases,  without  there 
being  any  actual  loss  of  power,  there  is  an  uncertainty 
and  unreliability,  with  respect  to  the  sexual  function, 
which  renders  the  individual  practically  impotent.  A 
sense  of  unnatural  or  intolerable  fatigue  after  temperate 
intercourse  is  another  common  phase  of  this  condition, 


70  NERVE    WASTE. 

and  many  apparently  healthy  men  with  perfectly  healthy 
sexual  organs  are  obliged  to  practice  the  greatest  care- 
fulness in  this  part  of  their  economy.  As  one  man 
expressed  it,  ( '  that  thing  tears  me  all  to  pieces. ' ' 

Involuntary  morbid  seminal  emissions  are  an  annoying 
symptom  which  may  occur  in  nervous  paupers  without 
any  foundation  of  excess,  or  any  local  weakness,  or  any 
cause  whatever,  excepting  the  unstable  condition  of  the 
spine.  This  form  of  spermatorrhoea  is  a  neurosis,  a 
purely  nervous  disease,  belonging  to  the  family  of  ex- 
plosive or  convulsive  disorders,  which  includes  epilepsy, 
St.  Vitus'  dance  and  hysteria.  The  emission  is  often 
started  or  set  off  by  anything  which  irritates  the  nervous 
system  in  the  slightest  degree,  as  an  indigestible  supper, 
an  evening  cigar,  coffee  or  emotional  excitement. 

SEXUAL  NEURASTHENIA. — There  are  several  ways  in 
which  civilized  man  is  injured  through  his  reproductive 
apparatus.  The  abuses  of  childhood  and  boyhood,  the 
strain  of  celibacy  in  an  environment  of  erotic  suggestion, 
the  folly  of  excess — often  added  to  overwork  (thus  burn- 
ing the  candle  at  both  ends),  and  the  frauds  against  con- 
ception, all  act  extensively  in  our  midst  to  produce  a 
type  of  disease,  which  is  widespread  and  important. 

The  unity  of  sexual  neurasthenia  is  not  at  present 
thoroughly  recognized  outside  of  neurological  literature, 
although  the  prominent  part  played  by  the  nervous  sys- 
tem in  functional  reproductive  disorders  long  since  led 
some  eminent  authorities  to  classify  them  among  ner- 
vous diseases  as  the  "The  Sexual  Neuroses."  But  in 
general,  sexual  neurasthenia  still  goes  by  a  variety  of 
names  ;  its  symptoms  are  treated  as  distinct  diseases  by 
many  practitioners,  and  are  so  described  in  many  stand- 
ard medical  works.  Sexual  hypochondriasis,  spinal  irri- 
tation, spermatorrhoea  and  impotence  are  often  functional 
disorders  of  the  same  apparatus,  having  the  same  causa- 
tion and  requiring  the  same  plan  of  treatment. 


SEXUAL   NEURASTHENIA.  7 1 

The  elements  of  sexual  neurasthenia  may  be  briefly 
described  as  follows  : 

CEREBRO-SPINAL  IMPAIRMENT. — No  function  involves 
the  output  of  so  large  a  quantity  of  nerve-force  in  so 
short  a  time  as  the  reproductive.  Sexual  excess  empties 
the  nerve-cells  most  quickly  and  effectively  of  their 
nerve-force,  and  if  persisted  in  establishes  a  chronic  irri- 
tability and  weakness  in  the  central  nervous  system. 
Here  is  nerve-waste  at  its  worst. 

REFLEX  IRRITATION. — The  repeated  and  other  pro- 
longed engorgements  which  attend  sexual  excitement,  and 
the  succession  of  irritating  impulses  transmitted  from  the 
brain  to  the  sexual  organs  in  habitual  mental  erotism,  are 
capable  of  producing  certain  morbid  changes  in  the  deep, 
reproductive  tissues.  These  consist  of  congestion,  in- 
flammatory patches,  irritable  points,  thickening  and  strict- 
ure of  the  urethra,  of  irritability  and  congestion  or  even 
chronic  inflammation  of  the  prostate  gland  and  of  an 
over-active,  over-sensitive  condition  of  all  the  reproductive 
tissues.1  Certain  eminent  authorities  have  denied  that 

!jean  Jaques  Rousseau  was  a  victim  of  sexual  neurasthenia,  if  we  are  to 
judge  from  his  famous  "  Confessions."  Concerning  his  case,  MM.  Grimaud  de 
Caux  and  Martin  Saint-Ange  (Histoire  de  la  G£neYation  de  1'Homme.  Paris,  1847J 
•ay:  "Lastly,  we  have  to  admit  the  existence  of  another  form  of  stricture  of 
the  urethra— that  caused  by  a  nervous  state  of  the  passage,  which  becomes  so 
greatly  contracted  that  its  calibre  is  wholly  obliterated  and  its  sides  brought 
into  contact.  Such  an  obstacle  to  urination  is  only  temporary,  lasting  at  most 
an  hour  or  two,  but,  by  its  frequent  repetition,  causing  much  suffering  to  those 
who  are  its  subjects.  It  was  such  an  affection  that  rendered  J.  J.  Rousseau  so 
unhappy,  and  so  insupportable  to  himself  and  to  others.  He  was  supposed  to 
suffer  from  stone  in  the  bladder.  Morand,  however,  could  never  discover  it  by 
Bounding,  so  Rousseau  had  recourse  to  Fr£re  C6me,  who,  having  penetrated 
to  the  bladder,  found  nothing.  This  examination  quieted  him  fora  time,  but 
the  urethral  spasm  reappeared,  and  hypochondria  supervened  to  darken  the 
mental  horizon  of  the  philosopher,  and  to  disgust  him,  as  every  one  knows, 
with  all  the  objects  of  his  love  and  friendship.  If  the  author  of  "  Emile  "  had 
lived  in  our  day,  with  its  scientific  progress  in  the  treatment  of  diseases  of  the 
urinary  passages,  it  is  more  than  probable  that  the  greater  part  of  his  life,  espe- 
cially the  close,  would  have  felt  the  full  power  of  his  character  and  genius, 
which,  being  of  late  development,  would  have  illumined  his  old  age."  This 
symptom  is  so  common  that  one  of  my  stock  questions  in  sexual  neurasthenia 
is,  "  Are  you  able  to  make  water  without  embarrassment  in  a  public  urinal?" 
In  twenty  per  cent,  of  aH  cases  the  answer  will  be, i:  No." 


72  NERVE    WASTE. 

stricture  of  the  urethra  can  result  from  sexual  excitement 
alone  and  claim  that  it  must  depend  upon  venereal  disease 
or  upon  injury.  Nothing  is  more  common  in  my  experi- 
ence than  thickened,  blotched  or  strictured  urethras  in  men 
who  have  never  had  gonorrhea  or  even  sexual  intercourse. 
These  changes,  once  established,  persist.  They  act  back- 
ward upon  spine-and-brain,  transmitting  a  continuous 
harassing  impression  which  irritates  and  depresses  the 
vitality  of  these  vital  organs.  Spinal  irritation,  spinal  in- 
stability, spermatorrhoea,  impotence,  are,  in  alarge propor- 
tion of  cases,  directly  dependent  upon  these  deep-seated 
morbid  conditions. 

SPINAL  IRRITATION. — Unsteady  circulation,  congestion, 
impaired  nutrition  and  over-sensitiveness  of  the  spinal 
cord,  is  a  common  symptom  in  all  forms  of  sexual 
neurasthenia. 

SPERMATORRHOEA. — The  unnatural  losses  of  sexual  im- 
pairment are  the  features  which  are  apt  to  give  the  patient 
most  anxiety,  but  they  are  by  no  means  the  most  important 
element  in  the  case.  In  some  cases,  these  losses  result 
chiefly  from  local  irritability  and  weakness  ;  in  others, 
more  from  a  habit  of  excessive  secretion  which  the  parts  have 
been  gotten  into;  and  in  others,  more  upon  spinal  instabil- 
ity; and  in  some  cases  all  three  of  these  conditions  operate. 
The  seminal  fluid  is  in  no  sense  a  vital  fluid  as  the  blood 
is,  and  its  loss  is,  intrinsically,  not  very  debilitating. 
Many  husbands  expend  seminal  fluid  almost  daily  for 
years,  or  a  life- time,  without  apparent  injury;  and  in  chil- 
dren before  there  is  any  secretion  to  lose,  and  in  females, 
bad  habits  may  produce  all  the  nervous  symptoms  of 
chronic  spermatorrhoea.  But  in  the  powerfully  depressing 
mental  effect  which  this  objective  symptom  often  produces, 
it  is  worthy  the  most  earnest  effort  on  the  part  of  the  physi- 
cian. The  excessive  nerve-waste,  the  reflex  irritation  of 
deep  reproductive  disease,  the  depressing  emotions  of 
anxiety  and  remorse  are  the  most  potent  factors  in  sex- 


SEXUAL    NEURASTHENIA.  73 

tial  neurasthenia  and  all  together  make  up  a  peculiarly 
distressing  form  of  disease. 

THE  URINARY  DEPOSITS,  which  are  common  in  all 
varieties  of  nervous  impairment,  are  a  source  of  great 
anxiety  to  sexual  neurasthenics.  Influenced  by  false 
statements  of  advertising  charlatans  tens  of  thousands  of 
"young,  middle-aged  and  old"  men  believe  that  their 
life-force  is  being  drained  by  spermatorrhoea.  It  is  a 
great  comfort  to  many  such  men  to  see  their  turbid  urine 
clear  up  in  a  second  on  the  application  of  suitable  chemi- 
cal tests. 

IMPOTENCE  may  be  temporary  or  permanent  ;  partial 
or  complete.  It  may  consist  in  unstriped  muscular-fibre 
atony  (relaxation  of  vein,  scrotum,  imperfect  erection  or 
failure  of  erection),  in  excessive  irritability,  local,  or  uni- 
versal throughout  the  whole  apparatus  (premature  ejacu- 
lation), in  atrophy  (diminution  in  size  of  the  external 
parts),  or  in  excito-secretory  failure  (deteriorated  seminal 
secretion — sterility),  or  in  all  together.  Behind  this 
symptom  is  the  great  fact  of  the  spinal  cord  and  sympa- 
thetic. The  external  genitals  are  the  instrument,  the 
spine  is  the  source  of  sexual  vigor  (tone,  erection,  ejacu- 
lation) and  of  sexual  life  (nutrition  and  secretion).  Dis- 
eases of  the  spinal  cord,  implicating  the  centres  of  sexual 
life,  are  attended  by  impotence.  If  the  nerves  which  con- 
nect nerve-centre  and  generative-organ  could  be  severed  all 
sexual  life  (growth,  secretion,  vigor)  would  cease.  Thus, 
when  the  spine  and  sympathetic  have  been  overdrawn  by 
excess,  or  when  they  have  been  depressed  for  years  by 
morbid  urethral  and  prostatic  impressions,  they  poorly  in- 
nervate or  vitalize  the  external  parts  and  sexual  impair- 
ment— debility  or  exhaustion — results.  Thus,  the  spine  is 
the  ultimate  organ  of  sexual  life,  and  the  great  objective 
point  in  any  scientific  treatment  of  this  symptom,  and 
thus  impotence  is  pre-eminently  a  nervous  disorder. 


74  NERVE  WASTE. 

SEXUAL  HYPOCHONDRIASIS —  SEXUAL  PATHOPHOBIA. — 
The  mental  depression  and  anxiety  of  sexual  neuras- 
thenia is  often  itself  a  symptom  of  central  nervous  im- 
pairment. Poorly  nourished  and  irritable  brain-cells  are 
apt  to  manifest  an  anxious  or  gloomy  quality  of  mind. 
Reproductive  impairments  and  especially  discharges,  of 
every  kind,  cause  a  mental  depression  in  nervous  persons 
that  is  in  striking  contrast  to  the  cheerfulness  of  graver 
diseases.  In  tuberculosis,  the  patient  is  often  cheerful 
and  hopeful  to  the  last ;  the  lungs  do  not  exert  the  same 
influence  over  the  brain  that  the  reproductive  organs  do. 

A  large  proportion  of  sexual  neurasthenics  labor  under 
false  or  distorted  conceptions  of  the  nature  and  gravity 
of  their  disease,  and  in  some  these  false  beliefs  attain  to 
the  gravity  of  real  insane  delusions.  One  of  these  delu- 
sions is  in  relation  to  the  intrinsic  effect  of  an  occasional 
seminal  loss.  The  tons  of  cheap  printing  which  are  cir- 
culated throughout  the  land  will  compare  favorably  with 
any  disease  germ,  in  the  amount  of  mental  and  nervous 
disorder  which  they  produce.  The  policy  of  these  books 
is  to  frighten,  and  to  this  end,  symptoms  and  conse- 
quences of  sexual  abuse  are  distorted  and  exaggerated 
with  great  ingenuity. 

A  common  statement  is  that  the  loss  of  a  single  drop 
of  seminal  fluid  is  equal  in  vital  waste  to  forty  ounces  of 
blood.  The  invalid,  ignorant  of  physiology  and  of  path- 
ology, knows  that  he  is  sick,  and  that  he  feels  a  wretched 
lassitude  and  weakness  after  such  a  loss,  and  this  state- 
ment strikes  him  with  all  the  force  of  truth.  He  becomes 
morbidly  watchful,  and  every  evidence  of  loss  depresses 
him  greatly.  I  have  lately  treated  a  young  man  weigh- 
ing one  hundred  and  sixty  pounds,  and  presenting  every 
external  evidence  of  health,  who  was  for  years  com- 
pletely unfitted  for  his  day's  work  by  a  weekly  emission; 
and  have  in  my  possession  numbers  of  letters  which  ex- 
press a  degree  of  mental  wretchedness,  amounting  to 


SEXUAL    NEURASTHENIA.  75 

agony,  because  of  this  single  symptom  and  without  an- 
other obvious  sign  of  disease.  Of  the  three  elements  of 
a  seminal  emission  in  nervous  individuals  (the  seminal 
loss,  the  nervous  discharge,  and  the  subsequent  mental 
depression)  the  last  is  far  the  most  potent.  In  certain 
patients  it  may  be  elicited  that  during  several  years  of 
sexual  abuse  they  retained  good  health,  but  that  upon 
discovering  the  awful  consequences  from  some  advertise- 
ment, and  upon  the  natural  appearance  of  seminal  emis- 
sions, habitual  worry  quickly  made  them  nervous  in- 
valids. If  we  could  persuade  sufferers  from  chronic 
nasal  catarrh  that  every  drop  of  mucus  lost  from  the  nose 
is  equal  to  forty  drops  of  blood,  and  that  this  disease  is 
bearing  them  to  the  insane  asylum  or  the  grave,  we 
could  thus  frighten  and  worry  thousands  of  these 
patients  to  death.  In  most  cases  of  sexual  neurasthenia, 
sexual  abuse  is  only  one  of  several  causes — among  hered- 
ity, over- work  or  sedentary  habits.  But  these  patients  are 
apt  to  attribute  all  their  weakness  to  their  own  folly,  and 
to  suffer  much  unnecessary  misery.  The  fact  that  sexual 
sufferers  must  generally  bear  their  troubles  in  secret, 
with  no  strong  arm  to  lean  upon  and  none  to  instruct  or 
advise  does  much  to  develop  morbid  notions. 

The  importance  of  these  mental  states  of  sexual  neuras- 
thenia does  not  always  receive  the  consideration  it  needs. 
Many  physicians,  estimating  this  disorder  upon  its  ob- 
jective and  pathological  features  alone,  look  upon  it  as  a 
trifling  matter.  Thousands  of  young  men,  who  every 
year  seek  help  from  their  family  physician,  are  met  with 
indifference  or  brusqueness,  or  receive  some  medicinal 
treatment  which  is  entirely  inadequate  in  the  case  ;  then 
the  patient  remains  miserable,  the  physician  misses  one  of 
his  greatest  opportunities  for  doing  good,  and  the  char- 
latan thrives. 

Remorse  for  the  past  and  anxiety  for  the  future  are 
terrible  forces  in  human  life,  and  the  fact  that  there  is 


76  NERVE    WASTE. 

often  no  true  foundation  for  these  emotions  does  not 
lessen  their  power.  Chronic  worry  is  capable  of  killing 
the  strongest  man,  and  many  a  pale-faced  boy  is  carry- 
ing about  a  secret  which  is  a  serious  matter  to  him,  and 
which,  of  itself,  depresses  his  vitality,  retards  his  growth 
and  distinctly  interferes  with  his  success  in  life. 

It  is  wiser  to  recognize  the  importance  of  the  mental 
phases  of  sexual  troubles,  and  to  set  to  work  sympathiz- 
ingly  and  kindly  to  remove  them.  It  requires  a  much 
higher  order  of  medical  skill  to  treat  a  disorder  which 
has  its  seat  in  the  mind  than  in  any  other  function  of  the 
body.  With  earnestness  in  both  physician  and  patient  sex- 
ual neurasthenia  is  one  of  the  most  certainly  curable  of  all 
nervous  disorders.  A  little  pains  taken  to  instruct  these 
patients  in  the  elements  of  sexual  physiology  and  patho- 
logy, will  achieve  a  success  in  practice  which  is  not  always 
granted  in  other  directions.  In  very  many  cases  the  fav- 
orable prognosis,  which  can  conscientiously  be  made  by 
the  physician  who  is  equipped  for  this  kind  of  work,  in 
substituting  bright  prospects  for  anxiety,  is  a  powerful 
remedy  to  begin  with.  And  if  in  his  intercourse  with  his 
patient  the  physician  be  imbued  with  a  broad  charity,  a 
kindly  sympathy,  and  an  earnest  desire  to  relieve  a  con- 
dition which  is,  in  some  respects,  peculiarly  unhappy,  this 
fact  will  often  be  as  truly  remedial,  in  its  way,  as  med- 
icines, electricity  or  any  tangible  remedy. 

THE  TREATMENT  OF  SEXUAL  NEURASTHENIA  varies 
according  as  general  nerve  weakness,  mental  depression, 
spinal  weakness,  irritability  and  instability,  deep-seated 
urethral  and  prostatic  changes,  or  local  debility  or  ex- 
haustion are  the  most  important  elements  in  the  case. 
Eliminative  treatment  is  essential  where  deep-seated 
morbid  processes  are  acting  to  keep  up  the  symptoms. 
Modern  instruments  and  procedures  render  the  deep 
reproductive  tissues  perfectly  accessible  to  the  surgeon, 
and  disease  therein  can  be  exactly  located  and  thoroughly 


SEXUAL   NEURASTHENIA.  77 

treated.  Teaching — giving  the  patient  clear  and  correct 
ideas  of  the  nature  of  his  trouble,  and  instructing  him  in 
its  hygiene — is  often  the  most  valuable  service  which  the 
physician  is  able  to  render  in  sexual  neurasthenia.  Re- 
storation, or  building  up  of  brain  and  spine,  or  of  the 
spine  alone,  and  in  many  cases  of  the  external  parts,  is 
accomplished  by  a  careful  hygiene,  electricity  and  a  wise 
use  of  every  force  which  can  be  included  under  the  word 
"tonic." 


XV 

SEXUAL  NEURASTHENIA  IN  THE  FEMALB 

The  reproductive  system  is  deficient  in  civilized 
woman.  Our  American  families  seem  to  be  decreasing, 
in  size,  and  it  is  fortunate  that  the  Republic  is  not 
wholly  dependent  upon  its  city  daughters  for  soldiers 
and  statesmen.  Child-birth  is  a  simple  process  in  primi- 
tive woman,  and  becomes  difficult,  or  complicated  or  dan- 
gerous, in  proportion  as  the  woman  is  civilized.  The 
great  development  of  the  baby-food  industry  in  the 
United  States  testifies  how  the  mammary  glands,  a  part 
of  the  reproductive  system,  are  failing.  It  is  getting 
somewhat'  rare  to  find  a  mother  in  the  higher  walks  of 
life  who  can  nurse  her  child  without  systematic  stimula- 
tion. 

Heredity  and  education  operate  extensively  to  weaken 
brain-and-spine,  and  dwarf  dependent  tissues.  A  pretty 
large  proportion  of  American  women  are  slender,  and 
have  clear-cut,  intellectual  faces,  and  expressive  eyes. 
They  are  interesting  or  delightful,  clever  or  brilliant  in 
conversation,  altogether  charming  as  companions,  and 
plucky  or  noble  as  wives.  But  the  physiologist  notes 
that  they  are  flat-chested,  narrow-hipped,  that  their  flesh 
is  not  firm,  that  they  lack  suppleness  and  endurance,  and 
he  knows  that  they  will  not  make  good  physical  wives 
and  mothers.  In  an  address  on  The  Modern  Tendency 
of  Disease,  the  late  Dr.  Fothergill  gave  an  ingenious 
account  of  the  manner  in  which  the  strain  and  over- 
draft of  civilization  stunts  the  purely  sexual  element  of 
women,  and  tends  to  reduce  her  to  a  neuter. 

There  are  several  forms  of  nervous  strain  which  act 
through  the  reproductive  apparatus  to  depress  and 

(78) 


SEXUAL   NEURASTHENIA   IN   THE    FEMALE.  79 

weaken  the  brain-and-spine.  Medical  men  alone  realize 
the  extent  to  which  woman's  dependency  upon  man  sub- 
jects her  to  abuses,  and  renders  her  liable  to  misfortunes 
in  this  part  of  her  economy.  The  strain  of  enforced 
celibacy,  that  of  excessive  and  unwelcome  exercise  of  the 
reproductive  apparatus,  which  are  widely  suffered  by 
women,  would  not  be  endured  by  man.  The  strain  and 
shock  of  unphysiological  manoeuvres  against  conception 
has  repeatedly  been  pointed  out  by  eminent  authorities, 
but  the  existence  of  such  things  is  largely  ignored  in 
medical  practise.  In  addition  to  these  strains  child- 
bearing,  nursing,  child-rearing,  household  drudgery  and 
domestic  worry  too  often  strain  and  wear  upon  the  nervous 
centres  from  several  directions  at  once. 

Uterine  and  ovarian  diseases  are  very  common  among 
American  women,  and  are  due  to  a  long  list  of  accidents 
and  mistakes.  Perhaps  no  class  of  cases  of  nervous 
symptoms  is  more  common  than  that  in  which  a  congested 
and  bent  womb,  or  a  misplaced  ovary  or  some  other 
local  disease,  is  the  chief  cause.  These  local  conditions 
often  continue  to  act  backward  along  the  nerves,  through 
months  and  years,  and  irritate  and  depress  the  vitality 
of  the  brain-and-spine  as  a  splinter  in  the  foot  might,  by 
its  disturbing  influence,  cripple  the  entire  leg.  Hysteria 
and  the  exaggerated  emotional  phenomena,  so  common 
among  delicately  reared  women,  are  generally  the  effect 
of  an  abnormally  sensitive  nervous  organization,  plus  some 
irritating  process  about  the  reproductive  organs. 

Nervous  impairment  in  woman  may  manifest  itself  in 
the  reproductive  organs.  In  woman,  as  in  man,  the  re- 
productive system  is  vitalized,  through  the  sympathetic 
nerve-centres,  by  the  great  vital  source,  the  brain-and- 
spine,  and  the  tone  of  these  tissues  is  apt  to  fluctuate 
with  the  general  health.  The  ill-regulated,  unsteady 
circulation  of  the  blood,  which  so  often  accompanies  de- 
ficient nerve-power,  may  include  a  congested  and  over- 


80  NERVE    WASTE. 

sensitive  state  of  the  spine,  womb  or  ovary.  In  these 
cases  the  irritable  spine,  the  irritable  womb,  and  the  irri- 
table ovary  are  best  considered  not  as  local  diseases,  but 
as  local  symptoms  of  a  general  nervous  deficiency, 
lyocal  treatment  alone  is  only  palliative  ;  cure  must  come 
in  caring  for  the  nervous  system. 

In  over- worked  women  menstruation  may  be  entirely 
suppressed  for  considerable  periods  when  the  reproductive 
system  is  defrauded  of  its  nerve-force  by  the  brain-and- 
spine.  In  a  class  of  114  young  women  who  were  study- 
ing midwifery,  Prof.  Schroeder  found  that  65  were  thus 
affected.  In  most  of  these  cases  menstruation  failed  soon 
after  beginning  the  course  of  study. 

In  the  treatment  of  associated  nervous  and  reproduc- 
tive disorder  in  the  female,  the  first  thing  to  be  accom- 
plished is  elimination,  abrupt  or  gradual,  of  everything 
that  is  working  for  the  disease.  The  laws  of  sexual 
hygiene  must  be  obeyed ;  chloral,  morphine,  alcohol,  if 
they  are  in  the  case,  must  go  out  of  it.  Irritating  impres- 
sions of  every  kind  must  be  removed  as  far  as  possible, 
which  will  often  necessitate  a  change  of  environment. 
If  ovarian  or  uterine  disease  is  acting  backward  to  irri- 
tate and  depress  the  brain  and  spine,  an  earnest  effort 
must  be  made  to  remove  it.  In  this  local  treatment  for 
nervous  disease  modern  surgery  has  achieved  some  of  its 
most  brilliant  successes.  After  the  enemies  have  been 
ousted  let  us  set  the  beneficent  forces  of  nature  at  work 
in  the  case,  and  they  will  not  disappoint  us.  The  suc- 
cessful treatment  of  nervous  disease  in  woman  requires 
an  earnest  physician,  an  earnest  patient,  and  favorable 
circumstances ;  this  is  why  so  many  curable  diseases 
remain  uncured. 


XVJ 

NERVE-WASTE    AND     LONGEVITY 

A  completed  lifetime  is  a  measure  of  nerve-force.  If 
the  brain  is  the  organ  of  mind,  and  the  spine  the  organ 
of  varied  functions,  the  brain-and-spine  together  is  the 
organ  of  vitality.  Every  child  inherits  a  vital  store 
which  may  be  conserved  to  fourscore,  or  so  lavishly  ex- 
pended or  so  severely  strained  that  literal  death  of  old 
age  may  occur  at  forty. 

Flourens  (De  la  Longevite  humaine.  Paris,  1855) 
taught  that  in  man,  as  in  animals,  the  period  of  growth  is 
to  the  period  of  life  as  one  is  to  five.  He  fixes  the  termina- 
tion of  growth  in  man  at  20  years,  when  the  epiphyses 
have  united  with  the  main  bones.  '  *  Man  grows  for  20 
years  and  lives  five  times  twenty  years;  that  is  to  say, 
100.  The  goat  grows  for  8  years  and  lives  to  40;  the 
horse  grows  for  5  years  and  lives  25  years,  and  so  with 
others, ' '  We  now  know  that  man  does  not  come  to  the 
end  of  growth  at  20,  but  continues  to  develop  to  30  and 
beyond;  but  it  is  true  that  with  a  fair  start,  and  a  favor- 
able environment,  man  may,  and  often  has,  lived  100 
years. 

We  may  distinguish  two  qualities  of  any  stock  of 
vitality — quantity  and  tenacity.  Some  men  of  appar- 
ently large  vital  resources  lack  resistance,  and  die  from 
slight  causes;  others,  frail,  nervous,  halting,  live  through 
every  strain  to  three  score  and  ten.  Certain  swords  will 
bend  double  under  a  weight  that  will  break  a  bar  of  pig 
iron  ;  endurance  is  a  better  quality  than  abundance. 

In  a  large  proportion  of  cases  chronic  nerve-weakness 
does  not  threaten  life ;  it  cripples  and  incapacitates  the 

6  (81) 


82  NERVE    WASTE. 

subject  and  may  render  him  more  or  less  miserable 
through  a  long  life.  It  has  even  been  stated  that  the 
neurasthenic  condition  in  some  degree  protects  the  indi- 
vidual against  acute  inflammations,  and,  as  a  fact,  acute 
diseases,  as  pneumonia,  are  not  very  common  among  this 
class  of  persons  ;  then  the  neurasthenic  individual  gets 
into  the  habit  of  taking  care  of  himself — after  he  becomes 
an  invalid — and  this  habit  protects  him  against  many 
causes  of  acute  disease.  So  with  many  nervous  invalids, 
especially  those  in  whom  the  digestive  powers  remain 
fairly  good,  the  chances  are  that  they  will  outlive  many 
of  their  more  robust  acquaintances. 

Within  a  few  years  some  authorities  have  stated  that 
certain  organic  diseases,  as  Blight's  disease,  and  dis- 
ease of  the  blood-vessels  of  the  brain  which  precedes  apo- 
plexy, are  sometimes  the  direct  result  of  chronic  ner- 
vous impairment ;  the  prolonged  ill  nourishment  of  the 
tissues  is  believed  by  these  observers  to  result  in  actual 
changes,  or  degenerations,  in  certain  organs. 

We  can  demonstrate  that  brain-and-nerve  weakness 
alters  the  nutrition  and  character  of  surface  organs — hair, 
skin,  nails,  and  reproductive  organs;  we  know  that  brain 
and  spinal  disease  often  precipitates  disease  in  joint, 
muscle  and  bone  ;  and  it  is  fair  to  suppose  that  this 
trophic  function  of  brain-and-spine  is  universal — reaching 
to  blood-vessel,  lung,  heart  and  digestive  organs. 

In  case  of  a  blighted  grape-vine  one  might  examine 
curiously  the  yellow  leaves  and  say,  * '  this  vine  has  the 
blighted  leaf,"  or — since  leaves  are  the  breathing  organs  of 
plants — "  its  lungs  are  diseased."  But  the  vine-dresser 
knows  that  far  down  at  the  roots  the  insidious  phylloxera 
is  sapping  the  life  of  the  vine,  and  that  the  diseased  leaf 
is  a  result,  and  not  a  cause. 

Nervous  impairment  is  the  chief  cause  of  death  in 
many  cases  described  by  other  names.  When  a  physi- 
cian is  called  to  a  diphtheritic  child,  or  to  a  pneumonitic 


NERVE    WASTE    AND    LONGEVITY.  83 

adult,  he  knows  that  his  duty  and  his  power  lies  largely 
in  nursing  his  patient's  vitality.  The  danger  is  lest  the 
poison  in  the  one  case,  or  the  acute  local  inflammation  in 
the  other,  against  which  our  science  has  as  yet  no  speci- 
fics, shall  depress  the  brain-and-spine  to  death.  With 
strong  (or  better)  enduring  patients  he  has  promising 
material,  and  with  these  he  most  easily  makes  his  cures. 
With  many  men  who  have  been  slowly  dying,  (brain-and- 
spine  exhausting)  for  five,  ten  or  fifteen  years,  a  pneu- 
monia or  a  typhoid  fever  is  merely  the  last  act  of  the 
drama.  The  enfeebled  brain-and-spine  is  unable  to  endure 
or  to  rally,  it  cannot  be  stimulated — there  is  nothing  to 
stimulate,  and  it  succumbs  to  a  sickness  which  an  unim- 
paired man  would  easily  endure,  and  safely  recover  from. 
When  such  is  the  case  it  is  a  pity  that  the  fact  cannot  be 
stated,  (for  the  lesson  there  is  in  it),  "  this  man  was 
worked  to  death." 


XVII 

THE     CURE     OP    NERVOUS     IMPAIRMENT 

Cure  is  care.  Curing  a  chronically  impaired  brain- 
and-spine  consists  in  taking  care  of  it.  As  with  horti- 
culturists, viticulturists  and  pisciculturists,  the  man  who 
knows  most  about  his  subject  and  the  forces  which  influ- 
ence it,  can  take  the  best  care  of  it.  This  cure  requires 
the  co-operation  of  many  different  remedies  in  proper 
proportion. 

The  realization  ( in  time ;  that  one  has  a  chronic 
nervous  disorder  is  an  important  pre-requisite  to  cure. 
This  realization  is  often  difficult  to  bring  about.  The 
carelessness  or  the  obstinacy  of  many  persons  in  estimat- 
ing the  importance  of  nervous  symptoms,  until  it  is  too 
late,  are  facts  of  constant  observation  in  medical  practice. 
Symptoms  are  nature's  warnings  that  her  laws  are  being 
violated,  or  that  something  has  gone  wrong.  A  nervous 
symptom  is  a  sign  that  something  is  wrong  with  the 
most  important  organ  in  the  body,  the  very  fountain 
of  life,  the  brain  and  spinal  cord.  When  such  a  sign  is 
given  it  is  the  part  of  wisdom  to  heed  it,  though  every 
other  sign  be  ignored. 

This  failure  to  realize  the  meaning  of  nervous  signs  is 
pathetic  when  its  consequences  fall,  as  they  often  do, 
upon  some  helpless  and  dependent  member  of  a  family. 
The  author  was  once  consulted  by  a  woman  whose  little 
girl  was  having  several  epileptic  fits  daily.  The  father 
of  the  child  refused  to  allow  her  to  receive  medical  treat- 
ment, because,  as  he  said,  "it  is  nothing  but  a  habit." 
This  was  strictly  and  scientifically  true,  but  what  worse 
habit  could  a  father  wish  his  child  to  have  ?  Another 

(84) 


THE  CURE  OF  NERVOUS  IMPAIRMENT.         85 

parent  whose  little  boy  was  developing  the  first  symp- 
toms of  St.  Vitus'  dance,  declined  to  take  him  out  of 
school,  "because  he  would  lose  his  examinations,  and 
besides  he  was  always  a  nervous  child,  and  this  is  noth- 
ing but  nervousness. ' '  The  physician  stands  dismayed 
before  what  must  seem  to  him  criminal  egotism  and 
neglect.  Of  course  such  persons,  who  so  confidentially 
place  their  knowledge  and  judgment  of  disease  above 
that  of  the  physician,  come  in  due  time  to  see  their 
error,  but  then,  too  often,  is  too  late.  The  writer  can 
point  to  a  half  dozen  cases  at  any  time,  where  indifferent, 
stolid,  brutal  or  parsimonious  neglect  to  heed  nervous 
signals  is  ruining  a  young  and  innocent  life,  crippling  a 
wife  and  mother  beyond  repair,  or  hurrying  a  whole 
family  toward  want  or  dependence. 

One  reason  why  nervous  symptoms  are  so  lightly  thought 
of — especially  when  they  occur  in  others  than  ourselves — is 
that  they  are  largely  subjective  and  not  material.  It  is  one 
thing  too  see,  and  another  to  recognize  the  significance  of 
what  we  see.  A  broken  bone  or  a  burned  skin  speak  for 
themselves,  inspire  sympathy  and  aid.  A  crippled  spine 
is  infinitely  more  serious  that  a  broken  arm,  but  it  is  out 
of  sight  and  manifests  its  inability  only  by  subtle  signs, 
which  do  not  appeal  to  the  senses.  But  when  we  hear  a 
person  spoken  of  as  being  ' '  only  nervous  or  hysterical  or 
' '  queer, ' '  we  must  remember  that  these  are  signs  that 
something  is  wrong  with  the  most  important  organ  in 
the  body.  Especially,  mental  symptoms  are  the  most 
important  of  all  disease  signs,  signifying  as  they  do  that 
a  brain  is  being  irritated  or  starved,  or  is  some  way  out 
of  order. 

Earnestness  in  the  patient  is  essential. — Very  many 
persons,  on  applying  to  a  physician  for  aid,  have  not  yet 
arrived  at  that  stage  in  the  history  of  their  disease  where 
they  are  willing  to  make  earnest  effort  to  get  well.  We 
hear  much  about  good  doctors,  but  less  about  good 


86  NERVE   WASTE. 

patients;  to  become  a  good  patient^  as  to  become  a  good 
doctor,  often  requires  several  years  of  bitter  experience. 
A  long  period  of  suffering  is  sometimes  necessary  to 
create  a  wisdom  that  will  not  scorn  true  remedies,  nor 
rebel  against  the  inevitable. 

A  physician  was  once  consulted  by  a  lady  for  certain 
nervous  symptoms.  Pains  were  taken  to  explain  how 
the  unnatural  and  unwholesome  way  of  living,  to  which 
she  had  become  accustomed,  was  at  the  bottom  of  all 
her  trouble,  and  that  this  must  be  radically  changed 
before  any  permanent  benefit  could  be  expected.  It 
afterward  transpired  that  she  had  not  been  favorably  im- 
pressed with  that  doctor's  ability.  As  she  reported, 
"Oh,  he  don't  know  anything;  he  told  me  a  lot  of  stuff 
about  diet  and  exercise,  but  he  said  he  couldn't  cure 
me. ' '  Now  this  lady,  who  is  simply  a  type  of  thousands, 
may  become  a  very  good  patient  for  some  doctor  in  the 
future,  when  her  symptoms  have  become  intolerable,  and 
when  cruel  experience  has  taught  her  that  there  is  no 
royal  road  to  health.  A  physician  cannot  cure  an  indiffer-  ' 
ent  or  a  passive  patient  in  chronic  disease,  more  than  a 
teacher  can  instruct  an  idle,  careless  or  rebellious  pupil. 
One  is  very  unfortunate  to  have  a  chronic  disease,  which 
is  often  both  troublesome  and  expensive  to  cure,  but 
having  it,  one  ought  to  do  the  best  he  can.  The  cure 
of  chronic  disease  may  be  considered  somewhat  in  the 
light  of  penalty  for  hygienic  sins.  It  would  even  be  a 
misfortune  if  all  chronic  diseases  could  be  quickly,  safely 
and  pleasantly  cured;  the  habits  of  men  and  women 
would  become  too  bad. 

Persistence  is  a  quality  which  is  essential  in  many 
cases  of  nervous  impairment.  A  chronic  disease  is  one 
which  has  become  slowly  established  in  the  system,  and 
is  even  in  some  cases  more  or  less  naturalized  there. 
Patients  sometimes  remark  that  they  would  not  feel 
natural  without  their  aches  and  pains.  Such  a  disease 


THE  CURE  OF  NERVOUS  IMPAIRMENT.         87 

cannot  be  forced  or  hurried  out.  In  most  cases  of  ner- 
vous impairment,  the  cure  is  a  matter  of  slowly  tearing 
down  old  diseased  tissue  and  building  up  new,  vigorous 
tissue,  just  as  an  old  ship  might  be  taken  on  the  stocks 
and  rebuilt,  by  replacing  each  rotten  plank  and  rusty 
bolt,  piece  by  piece,  with  new  ones.  The  pedagogic  func- 
tion of  the^physician  often  operates  to  hold  the  patient 
to  his  course.  Of  the  boys  who  every  year  begin  their 
studies  with  enthusiasm,  a  large  number  would  not  per- 
severe unless  they  were  held  to  it  by  some  power  out- 
side themselves,  and  so  it  is  with  chronic  invalids.  A 
burly  athlete  will  train  for  months  that  he  may  win  a 
contest ;  the  nervous  cripple  must  often  train  for  years, 
or  even  a  lifetime,  that  he  may  work  well  and  live 
happily. 

The  individuality  of  the  physician  is  sometimes  an  im- 
portant element  in  the  cure.  Over  and  above  purely 
scientific  attainments,  the  peculiar  characteristics  of  a 
physician  may  make  him  of  priceless  value  to  one  class 
of  patients,  and  of  no  use  at  all  to  others.  In  general, 
the  physician  is  most  successful  who  is  able  to  inspire 
confidence  in  his  patient,  to  exert  a  certain  amount  of 
influence  and  authority  over  him,  to  encourage  and  in- 
spire him  to  earnest  effort.  And  if  he  have  a  large 
vitality,  a  scientific  enthusiam,  an  interest  in  his  patient, 
and  a  pluck  which  rises  with  difficulty  and  leads  him  to 
exhaust  the  resources  of  his  art  before  acknowledging 
himself  baffled,  these  will  often  prove  saving  qualities. 
Trained  senses,  special  wisdom,  trained  judgment,  earnest- 
ness, honesty,  are  the  qualities  which  make  a  physician; 
of  these,  skill  and  honesty,  are,  it  is  to  hoped,  common. 
But  earnestness,  enthusiasm,  a  keen  sense  of  responsi- 
bility, anxious  thought,  are  not  always  possible.  These 
are  qualities  which  are  often  given  by  physicians,  but 
which  cannot  be  bought.  They  are  often  inspired  or 
repelled  by  the  patient  himself.  An  earnest  patient  stimu- 


88  NERVE    WASTE. 

lates  the  physician  to  his  best  work  ;  the  careless  throw 
cold  water  upon  enthusiasm,  and  cool  it  to  duty,  and  we 
all  know  the  difference  between  the  two. 

PRINCIPLES  OF  TREATMENT. — An  eminent  authority, 
the  late  Dr.  Beard,  wrote  : 

' '  Each  case  of  neurasthenia  is  a  study  of  itself.  ...  If 
two  cases  are  treated  precisely  alike  in  all  .-the  details 
from  beginning  to  end,  it  is  probable  that  one  of  them  is 
treated  wrong." 

But  while  this  is  true,  there  are  certain  broad  princi- 
ples which  must  be  followed  in  every  case  : 

1.  Certain   adverse    symptoms  which   act   as   direct 
obstacles  to  improvement  must  be  allayed  or  removed  ; 
among   these   are  sleeplessness,   neuralgia  or   headache, 
worry,  indigestion,  etc. 

2.  I^ocal  disorders  which  are  maintaining  or  aggra- 
vating the  nerve  weakness  must  be  radically  cured;  such 
are  eye-strains,  irritations  about  the  nasal  passages,  stom- 
ach disorders,  irritations,    congestions,    and  relaxations 
about  the  reproductive  organs  in  either  sex.     Many  of 
these  local  disorders  are  obvious  ;  others  are  unsuspected 
or  masked,  and  are  only  ferreted  out  by  the  comprehen- 
sive knowledge  of  the  physician. 

3.  Brain  and   nerve  nutrition.     The  central  nervous 
system  must  be  reinvigorated,  or  recharged  with  vitality. 
This  renewal  of  vital  force  is  not  affected  by  stimulation, 
which  is   temporary   and  injurious,  but  by   gently   and 
surely  toning  and  building  up  the  tissue  and  capacity  of 
the  nerve-cells,  to  stay  so.     This  last  result  is  often  pos- 
sible only  after  the  other  two  principles  of  treatment  have 
been  effected. 

The  available  vital  resources  existing  or  remaining  in 
any  case  largely  determine  the  result  of  caring  for  the 
brain-and-spine.  When  a  business  house  suspends,  and 
examination  shows  merely  a  temporary  entanglement,  or 
disproportion  of  immediate  assets  and  liabilities,  the 


THE  CURE  OF  NERVOUS  IMPAIRMENT.         89 

creditors  breathe  freely,  there  is  a  straightening  out,  a 
realizing,  and  after  a  time  business  is  resumed.  But 
when  speculation  or  bad  management  has  exhausted  the 
capital,  the  only  course  is  to  go  out  of  business,  or  to 
recommence  in  humble  style.  In  nervous  impairment 
the  prospects  are  generally  good  in  persons  under  thirty- 
five,  since  up  to  this  age  or  beyond  man  is  yet  maturing, 
still  on  the  up-grade,  and  nature  is  capable  of  great 
things  at  this  time  of  life.  Later  in  life  the  pros- 
pects are  not  so  uniformly  good,  though  some  of  the 
most  satisfactory  results  of  care,  which  I  have  seen,  have 
been  in  elderly  persons. 

To  accomplish  these  results,  the  physician  has  choice 
of  a  great  variety  of  remedies,  and  is  offered  a  wide  field 
for  the  exercise  of  his  judgment.  The  remedies  used 
against  nervous  impairment  may  be  ranged  in  two 
classes  :  First,  hygienic  remedies,  the  healing  power  of 
nature,  when  nature  is  given  a  chance.  Second,  the 
medicines  and  procedures  which  scientific  medicine  has 
learned  in  centuries  of  experience  and  study.  In  most 
cases  both  classes  of  remedies  are  needed  to  effect  the 
cure.  In  some  cases  health  is  restored  by  means  of 
hygienic  remedies  alone,  without  the  use  of  drugs  or  of 
surgical  skill,  but  it  is  seldom  that  the  reverse  is  true,  and 
that  medicine  and  local  treatment  cure  without  some 
obedience  to  those  natural  laws  which  rest,  immutable 
and  inexorable,  upon  every  human  life. 


XVIII 

REST    AS    A    REMEDY 

The  "rest  cure  "  in  some  form  or  in  some  degree  is  an 
essential  factor  in  the  treatment  of  nearly  every  case  of 
nervous  impairment ;  it  is  the  foundation  remedy.  Rest 
for  brain-and-spine  means  economy  in  action  and  peace 
from  passion.1 

ECONOMY  IN  ACTION  is  a  simple  proposition,  but,  simple 
as  it  is,  the  inability  or  refusal  of  many  persons  to  realize 
it  is  the  one  thing  that  renders  their  cure  impossible. 
When  a  patient  becomes  well  impressed  with  this  prin- 
ciple of  brain-and-nerve  saving,  of  the  prudent  manage- 
ment of  his  or  her  particular  nervous  resources,  he  has 
made  a  long  stride  toward  health. 

The  comparison  of  nerve-force  with  money  has  long 
been  a  favorite  one  with  physicians,  and  "  nerve  income," 
' '  nerve  expenditure, "  ' '  nerve  failure, "  ' '  physiological 
bankruptcy,"  "below par,"  are  phrases  in  common  use  as 
illustrations.  Most  men  are  careful  of  their  money  ;  they 
realize  that  when  their  capital  is  slowly  and  surely  dimin- 
ishing, they  are  in  a  bad  way.  When  the  merchant's  profits 
fall  below  expenses,  he  does  not  buy  a  lottery  ticket  and 
continue,  but  reduces  expenses  and  practices  a  careful  econ- 
omy until  business  is  better.  But  when  the  same  mer- 
chant finds  his  health  becoming  injured  from  over- work, 
he  is  not  apt  to  practice  a  like  wisdom  in  respect  to  his 
life-force  that  he  does  in  respect  to  his  money.  It  is  hard 
to  get  him  to  cut  down  expenses  at  a  time  when  he  should; 

1 "  Passion.  L,atin  passio,  from  patior,  to  suffer.  1.  The  impression  or  effect 
of  an  external  agent  upon  a  body  ;  that  which  is  suffered  or  received." — Web- 
ster. 

(90) 


BEST   AS   A    REMEDY  9! 

he  demands  a  ' '  tonic, ' '  and  relies  on  that.  Brain  and 
nerve  economy  is  not  usually  popular  with  patients ;  it 
interferes  with  their  plans,  and  involves  sacrifices,  efforts, 
trouble ;  the  hypophosphite  and  the  nerve-food  man  seem 
to  offer  a  much  pleasanter  means  of  cure. 

A  few  weeks  of  rest  from  work,  worry  and  irritating  im- 
pressions, is  the  most  rational  treatment  in  cases  of  simple 
nervous  impairment  from  over-work,  and  one  which  will 
often  be  real  pecuniary,  as  well  as  vital  economy. 

Victims  oi  over- work  might  be  divided  into  two  classes ; 
those  who  can  take  a  vacation  and  those  who  cannot. 
Unfortunately,  a  large  proportion  of  cases  belong  in  the 
latter  class;  they  cannot  leave  their  posts;  they  must 
work,  and  cannot  help  worrying. 

.  In  these  cases  it  is  often  possible  to  suggest  ways  in 
which  the  evil  may  be  lessened,  and  in  which  careful 
economy,  outside  of  work,  may  enable  a  man  to  about 
keep  even.  The  lodge,  church,  and  other  forms  of  night 
and  Sunday  work,  or  the  worrying  and  scheming  out  of 
work-hours,  which  is  habitual  with  many  men,  may  be 
the  straw  that  breaks  the  camel's  back.  Those  social 
obligations  which  are  not  recreations  may  be  advantage- 
ously sacrificed,  and  the  amount  of  sleep  increased.  If 
such  a  man  can  habituate  himself  to  sleep  ten  or  twelve 
hours,  for  a  time,  so  much  the  better;  sleep  is  nerve- 
income. 

Worry,  as  the  reader  knows,  is  seldom  suppressible  by 
effort  of  the  will;  this  evil  must  be  met  by  a  method  of 
substitution  or  displacement;  it  must  be  kept  out  or 
crowded  out;  to  this  end,  cultivate  a  hobby. 

In  every  large  city  there  are  men  who  find  the  fight  too 
bitter,  or  the  burdens  too  heavy.  Many  a  man  has 
found  peace  and  happiness  for  himself  and  his,  in  retir- 
ing once  and  for  all  from  the  ceaseless  wear-and-tear  of 
city  life,  and  in  making  a  home,  however  humble,  in  the 
country. 


92  NERVE    WASTE. 

REST  FROM  IRRITATING  IMPRESSIONS  is  often  more  diffi- 
cult to  command  than  economy  in  action.  An  injured 
thumb  is  apt  to  be  surrounded  by  a  bandage,  held  in  a 
certain  position,  and  protected  with  excessive  carefulness 
against  touches  and  jars  until  it  gets  well.  Man  will 
' '  favor ' '  a  sprained  ankle  for  months  or  years  if  need  be. 
The  oculist  secludes  certain  patients  in  darkness  for 
weeks  or  months,  to  protect  a  diseased  eye  from  the  stim- 
ulus of  the  most  subdued  light.  A  similar  protection 
must  sometimes  be  thrown  about  a  crippled  brain-and- 
spine.  Years  ago  Dr.  Mitchell  in  a  great,  little  book1 
told  how  he  managed  certain  cases,  chiefly  women  in 
gpoclcircumstances.  who  had  been  under-worked  and 
over-doctored  into  a  condition  of  chronic  nervous  exhaus- 
tion.±ie  exacted  implicit  obedience,  isolated  them  from 
relatives  and  friends,  put  them  to  bed,  and  by  a  combi- 
nation of  continuous  rest,  peace,  forced  feeding,  massage 
and  electricity,  without  medicine,  returned  many  of  these 
hopeless  cases  to  their  friends,  plump  and  rosy. 

The  principles  of  brain-and-spine  protection  and  saving, 
involved  in  Dr.  Mitchell's  rest  cure,  are  now  everywhere 
practised  in  suitable  cases,  though  it  is  not  always  nor 
often  that  the  laity  understand  or  submit  to  such  a 
strange  proceeding.  When  a  nervous  person  is  mani- 
festly irritated  by  his  surroundings,  he  should  be  re- 
moved out  of  them  if  possible.  Here  is  one  beneficial 
effect  of  change.  Where  change  is  not  possible,  such 
persons  should  receive  a  good  deal  of  consideration  from 
those  about  them.  It  often  happens  that  nervous  suffer- 
ers, irritable  and  fretful,  arouse  the  hostility  of  others,  and 
that  the  social  atmosphere  in  which  they  live  is  seldom 
calm.  In  these  cases  the  doctor  is  able  to  explain  the 
inwardness  of  things,  and  to  secure  some  degree  of  tran- 
quility  for  a  household. 

In  cases  of  reflex  nerve- weakness,  where  eye,  ear,  nose, 

1 "  Fat  and  Blood  and  How  to  Make  Them." — Philadelphia.    1877. 


REST   AS   A    REMEDY.  93 

womb  or  prostate  is  acting  backward  to  irritate  brain- 
and-spine,  the  removal  of  these  conditions  is  only  one 
step  toward  securing  rest  for  the  organ  of  vitality.  The 
interdiction  of  stimulants  and  narcotics,  and  all  unwhole- 
some excitements,  has  the  same  purpose. 

SLEEP  is  the  most  valuable  form  of  brain-rest.  During 
the  hours  of  sleep  the  out-put  of  nerve-force  is  reduced  to 
a  minimum,  and  at  the  same  time  the  blood  is  busily 
repairing  the  wear  and  tear  of  the  day.  The  oxygen  of 
the  blood  unites  with  the  worn-out  tissues,  and  heat  is 
evolved  in  this  process.  This  heat  is  converted  into  vital 
force,  as  the  heat  of  an  engine  may  be  converted  into 
electricity  for  lighting  or  other  purposes,  which  vital 
force  is  stored  up  in  the  brain-cells  for  use  the  next  day. 
Thus,  each  morning  we  awaken  with  our  brain  and  nerve 
tissues  charged  with  the  vigor  of  life.  Sleep,  which  the 
poet  long  ago  described  as  "tired  nature's  sweet  re- 
storer, ' '  has  in  these  days  become  a  remedy  ;  and  in  the 
great  asylums  and  hospitals  where  nervous  and  mental 
disorders  are  treated,  the  value  of  prolonged  sleep  is 
understood  and  utilized. 

The  essential  phenomenon  of  sleep  is  lessened  blood- 
flow  to  the  brain.  But  whether  this  nightly  recurring 
ebb-tide  in  the  brain  is  the  cause  of  sleep,  or  whether  (as 
some  assert)  the  brain-cell  itself  originates  the  impulse 
(by  inherent  law,  or  established  habit,  or  by  both)  which 
slackens  heart-beat,  slows  blood- current,  and  leaves  the 
brain  in  peace,  physiologists  differ. 

SLEEPLESSNESS. — The  nineteenth  century  worker  needs 
often  to  pray,  '  'give  us  this  night,  our  nightly  rest' '  more 
than  "give  us  this  day  our  daily  bread."  Insomnia  is 
an  increasing  symptom  in  medical  practice. 

There  are  two  elements  in  a  good  night's  sleep,  getting 
to  sleep  and  staying  there;  one  may  fail  in  either  of  these: 

i.  When  the  circulation  is  badly  managed  and  un- 
steady, as  explained  in  a  preceding  chapter. 


94  NERVE   WASTE. 

2.  When  the  brain  remains  engorged  with  blood,  be- 
cause enfeebled  blood-vessels  (their  middle  wall  of  un- 
striped  muscular  fibre  being    feebly   innervated    by   an 
insufficient  sympathetic  system)  cannot  contract  upon, 
and  empty  themselves  of  their  surplus. 

3.  When  irritable  brain- cells  easily  attract  the  blood- 
stream to  the  brain,  whence  enfeebled  vessels  are  enabled 
to  remove  it. 

Many  schemes  and  recipes  against  sleeplessness  are 
in  circulation,  but  the  only  one  that  is  applicable  to  all 
cases  is,  Discover  and  eliminate  the  cause  of  it.  Nature 
is  uncompromising  when  her  laws  are  disregarded,  and 
her  penalties  are  not  easily  softened  or  escaped.  The 
devices  in  vogue  for  this  purpose  of  lessening  the  penalty 
of  brain  mis-use  may  be  classified  as  follows  : 

i.  Those  which  act  by  soothing  an  irritated  brain, 
and  by  breaking  off  the  current  of  the  day.  A  half-hour 
of  light  reading  or  of  cheerful  conversation,  or  a  cigar  at 
bedtime,  may  so  tranquilize  the  brain-cells  that  sleep  is 
possible.  The  hop-pillow  of  our  ancestors  perhaps  acts  as 
much  through  the  imagination  as  by  any  subtle  emanation 
of  lupuline.  But  twenty  to  forty  drops  of  the  fluid  extract 
of  lupuline  in  a  dessert-spoonful  of  the  syrup  of  lettuce  is 
excellent  for  the  sleeplessness  of  advanced  life  and  is  free 
from  danger. 

I  believe  that  music  can  be  made  a  valuable  remedy 
in  many  cases  of  nervous  impairment.  I  know  a  man 
who,  when  evening  finds  him  harassed,  anxious,  excited 
by  the  experiences  of  the  day,  takes  out  his  violin  and 
soothes  his  irritated  brain,  and  allays  the  tension  of  his 
strung  nerves  by  the  simple  melodies  which  he  is  able  to 
play.  An  hour  of  cheerful,  agreeable  music  before  retir- 
ing is  worth  the  trial  of  any  victim  of  nervous  insomnia; 
the  fact  that  the  invalid  has  no  skill  or  ear  in  music  need 
not  deter  him  from  a  trial  of  this  advice.  He  must  re- 
member that  the  purpose  of  learning  and  performing  is 


REST   AS   A    REMEDY. 


95 


not  so  much  the  edification  of  others  as  the  soothing 
of  his  irritable  nerve-cells,  and  the  keeping  out  of  worry 
and  care.  We  read  in  the  Old  Testament  that  ' '  David 
took  a  harp  and  played  with  his  hand  ;  so  Saul  was 
refreshed,  and  was  well,  and  the  evil  spirit  departed  from 
him.''  Martin  lyUther  wrote  "  Next  to  theology  I  give 
the  highest  place  to  music,  for  thereby  anger  is  forgotten, 
the  devil  also  ;  melancholy  and  many  tribulations  and 
evil  thoughts  are  driven  away."  The  future  may  bring 
the  primitive  minstrel  once  more  upon  the  scene,  and 
weird  chant  or  plaintive  melody  may,  in  some  cases,  take 
the  place  of  chloral. 

Some  such  quiet  method  of  diversion  is  suitable  when 
the  theatre  or  even  a  social  evening  away  from  home 
would  be  too  exciting  or  too  tiresome. 

The  plans  of  counting,  or  imagining  a  flock  of  jumping 
sheep,  or  a  dripping  icicle,  or  reading  a  dull  book, 
sometimes  succeed  by  displacing  other  thoughts,  and  by 
the  soothing  influence  of  monotonous  impressions.  The 
somniferous  influence  of  a  dull  sermon  is  well-known. 
Many  impressions  acting  upon  the  nerves-ends  of  the  skin 
soothe  the  irritated  nervous  tissue;  riding  in  the  wind 
will  make  many  persons  sleepy,  and  the  hot  bath  and 
massage  act  in  part  thus. 

2.  Gentle  stimulus  often  soothes  the  brain — perhaps 
counter-irritates  it,  as  scratching  allays  an  irritation  of 
the  skin,  or,  in  other  cases,  enables  it  to  rid  itself  of 
blood.  A  small  glass  of  beer,  or  one  of  the  wine  of  coca 
and  even  the  nightcap  of  whisky,  which  I  do  not  advise, 
will  often  favor  sleep.  Dr.  I^auder  Brunton  recently  re- 
ported that  a  small  dose  of  strychnia  (a  powerful  nerve- 
tonic)  at  bedtime  is  often  efficacious  against  the  sleepless- 
ness of  brain-tire;  a  half  grain  or  more  of  quinine  will 
sometimes  act  in  the  same  way.  A  patient  who  has  tried 
all  the  common  plans  against  sleeplessness  informs  me 
that  a  dozen  or  twenty  deep  inspirations  are  effectual. 


g6  NERVE    WASTE. 

This  loading  the  blood  with  excess  of  oxygen  acts  as  a 
a  stimulus  to  brain  cell,  and  to  the  circulation.  The 
electrical  procedure,  known  as  central  galvanization,  is 
very  efficacious,  and  acts  by  stimulating  the  sympathetic. 

3.  Many  plans  succeed  in  withdrawing  blood  from 
the  brain.  A  light  supper  of  raw  oysters,  or  a  crust  of 
bread,  with,  perhaps,  a  glass  of  beer  at  bed-time  may 
divert  the  blood- wave  from  brain  to  stomach,  and  thus 
induce  sleep.  A  short  walk  in  the  open  air,  a  brisk  rub- 
bing with  a  flesh  brush,  or  a  coarse  towel  may  be  useful. 
All  but  complete  immersion  in  a  hot  mustard  bath  (only 
the  nostrils  and  mouth  remaining  above  the  surface)  has 
served  me  well,  and  acts  not  alone  by  calling  the  blood 
to  the  surface,  but  by  exerting  a  universal  soothing  influ- 
ence (through  the  nerve-ends)  upon  the  brain.  Massage 
acts  in  a  similar  manner. 

Habit  has  much  to  do  with  certain  cases  of  sleepless- 
ness ;  many  physiologists  consider  sleep  to  be  largely  a 
brain-habit.  Some  persons  get  into  a  habit  of  lying 
awake,  or  of  regularly  waking  at  some  unseasonable 
hour  ;  in  such  cases  a  complete,  abrupt  change  of  en- 
vironment and  action  will  often  break  the  bad  brain-habit 
and  restore  the  ability  to  sleep. 

When  simple  plans  do  not  succeed,  and  sleeplessness 
becomes  habitual,  the  aid  of  the  physician  must  be  in- 
voked. Prolonged  insomnia  may  lead  to  the  gravest 
results;  it  is  sufficient  of  itself  to  produce  not  only  com- 
plete nervous « exhaustion,  but  even  mania  and  other 
forms  of  true  insanity.  The  careful  physician  of  to-day 
only  makes  use  of  chloral  and  other  hypnotic  drugs  as  a 
last  resort,  and  then  confidently,  because  he  knows  his 
tools.  It  sometimes  happens  that  a  habit  of  sleepless- 
ness can  be  broken  by  a  wise  use  of  drugs,  and  that  four 
or  five  nights  of  drug  sleep  will  establish  a  habit  of 
natural  sleeping.  The  genius  of  modern  chemistry  has 
placed  in  the  hands  of  the  physician  certain  drugs  against 


REST   AS   A    REMEDY.  97 

sleeplessness,  which  have  the  advantage  of  being  (as 
we  now  believe)  comparatively  harmless.  Paraldehyde, 
diaethysulphondimethylmethan,  mercifully  abbreviated  to 
"sulfonal,"  urethan,  antipyrin,  acetanilide  and  amyl- 
ene-hydrate  are  brain  sedatives  of  the  highest  value  in 
suitable  cases.  But  by  means  of  the  hot  bath,  the  Turk- 
ish bath,  electricity,  massage,  and  in  some  cases  certain 
mechanical  contrivances,  it  is  often  possible  to  manage 
insomnia  without  the  use  of  drugs. 

In  those  callings  requiring  night  work  and  day  sleep, 
the  day  sleep  can  never  be  made  to  yield  the  same  restor- 
ation of  nerve-force,  nor  to  afford  the  same  rest  to  the 
brain-cells  that  night  sleep  does.  The  nervous  organs 
are  very  susceptible  to  the  stimuli  of  light  and  sound, 
and  thus  a  degree  of  tension  is  maintained  even  in  appar- 
ently sound  day  sleep  ;  but  even  where  a  perfectly  quiet 
and  darkened  room  is  available  for  day  sleep,  some  ele- 
ment of  natural  sleep  seems  to  be  wanting. 

7 


XIX 

THE     OUTING     CURE 

We  have  noted  the  part  that  oxygen,  the  essential  ele- 
ment of  the  air  we  breathe,  plays  in  the  production  of 
nerve -force.  Oxygen  reddens  the  blood;  when  the  dark, 
almost  black,  blood  of  the  veins  is  exposed  to  the  air  in 
the  lungs,  it  instantly  takes  on  the  vivid  scarlet  hue  of 
arterial  blood.  A  daily  full  supply  of  out-door  air  is  the 
most  valuable  tonic  and  vitalizer  for  the  nervous  system 
in  existence — without  any  exception.  One  to  six  thou- 
sand lungfuls  (not  sniffs)  of  out-door  air  taken  daily  for 
a  few  months,  will  accomplish  more  toward  restoring  the 
vigor  of  an  impaired  nervous  system  than  will  phospho- 
rus, hypophosphites,  iron,  quinine,  strychnine,  coca,  or 
any  of  the  other  substances  classified  as  nerve  tonics,  and 
more  than  the  wisest  combination  of  these  medicines  can 
accomplish,  without  this  remedy. 

Oxygen  exerts  a  direct,  positive,  certain  influence  upon 
the  nutrition  and  life  of  the  nerve-cells  ;  under  its  influ- 
ence nerve-force  is  made  more  rapidly  and  in  larger 
quantity,  and  a  larger  amount  of  food  is  able  to  be  assim- 
ilated; it  is  a  tonic  in  the  best  sense  of  that  much-abused 
word.  For  these  reasons,  nervous  invalids  should  spend 
as  much  time  as  possible  in  the  open  air.  It  is  not 
meant  to  advise  an  indiscriminate  exposure  to  all  airs  for 
feeble  persons.  Oxygen,  like  all  good  remedies,  may  be 
so  unwisely  used  as  to  do  harm,  and  weather  and  climate 
are  the  correctives  in  an  oxygen  prescription. 

SUNSHINE  is  a  disinfectant;  how  it  sweetens  out  a  foul, 
sick  room  ;  it  is  both  tonic  and  sedative  to  the  nervous 
system ;  the  bracing  and  cheering  influence  of  fine 

(98) 


' 


THE    OUTING    CURE.  99 

weather  is  familiar  to  everyone.    Nervous  invalids  should, 
if  possible,  sleep  in  an  air  which  has  been  warmed 
sunshine — in  a  southern  or  western  chamber. 

MUSCULAR  EXERCISE  quickens  the  blood-current,  equal- 
izes the  circulation,  stirs  up  the  nutritive  processes,  im- 
proves appetite,  digestion  and  assimilation,  helps  excretion 
'  and  favors  sound  and  refreshing  sleep.  The  use  of  exercise 
as  a  remedy  in  nervous  impairment  is  not  muscle-build- 
ing, but  brain-and-spine  building,  and  to  this  end  it  must 
be  modified  in  three  ways: 

1.  It  must  take  place  as  much  as  possible  in  the  open   j 
air.     These  oxygen   inhalations  from  nature's  reservoir    , 
are,  for  most  nervous  persons,  the  most  beneficial  element 
of  exercise. 

2.  It  must  be  agreeable.     Brain-rest,  or  brain-change, 

is  an  element  of  exercise  which  is  the  most  important  in  ' 
certain  cases  and  essential  in  all.  Muscular  exercise,  to 
which  one  must  drive  himself,  or  be  driven,  is  still  work 
and  not  play,  nervous  out-put  and  not  income.  "I  am 
alarmed,"  wrote  Thoreau,  "  when  it  happens  that  I  have 
walked  a  mile  into  the  woods  bodily  without  getting  there 
in  spirit.  In  my  afternoon  walk  I  would  fain  forget  all 
my  morning  occupations  and  my  obligations  to  society. 
But  it  sometimes  happens  that  I  cannot  easily  shake  off 
the  village.  The  thought  of  some  work  will  run  in  my 
head,  and  I  am  not  where  my  body  is — I  am  out  of  my 
senses. ' ' 

3.  It  must  be  proportionate  to  the  strength  of  the  in-   \ 
dividual — like  a  bottle  of  medicine,  exercise  has  its  dos- 
age and  directions   for   use.     Exercise  of  the  muscular 
system  has  long  been  looked  upon  as  a  kind  of  antidote  to 
ill-effects  of  sedentary  life,  and  muscular  development  has 
been  confounded  with  health.     By  systematic  training,  a 
man  may  build  up  large  muscles  and  still  be  far  from 
well,  and  it  is  a  fact  that  professional  athletes  are,  as  a 
class,  short-lived.     Muscular  exercise  involves  the  expen- 


100  NERVE    WASTE. 

diture  of  nerve-force,  and  he  whose  nervous  resources  are 
limited,  should  be  careful  not  to  expend  too  much  in  this 
direction.  A  half-hour  at  tennis  may  leave  a  man  glow- 
ing and  invigorated,  when  two  hours  of  it  will  fag  and 
injure  him.  For  the  comparatively  strong,  who  are  suf- 
fering from  some  of  the  minor  forms  of  nervous  impair- 
ment, long  days  of  hunting  or  fishing,  mountain-climb- 
ing, which,  according  to  Tyndall,  ' '  rescues  the  blood  from 
that  fatty  degeneration  which  a  sedentary  life  is  calculated 
to  induce, ' '  or  even  regular  labor  in  the  orchard  or  vine- 
yard may  be  of  great  benefit;  but  for  more  or  less  enfeebled 
persons,  some  light  form  of  exercise,  as  walking,  riding 
or  sailing,  is  best.  Solitary  exercise  in  the  gymnasium  is 
of  little  benefit  to  the  nervous;  the  putting  up  of  dumb- 
bells, the  use  of  the  health-lift,  the  "parlor  gymnasium," 
and  the  various  devices  resorted  to  from  a  feeling  of  duty 
are,  so  far  as  a  weak  nervous  system  is  concerned,  far 
inferior  to  merely  sauntering  in  the  open  air.  Frequent 
holidays,  vacations  and  Sundays  spent  out-of-doors  will 
enable  many  an  over- worked  and  worried  city  man  to  hold 
his  own  in  the  face  of  very  adverse  circumstances. 

The  taste  for  out-of-door  life  (often  wanting  in  the  city 
neurasthenic)  must  be  cultivated.  As  boys  we  have  this 
taste,  and  lose  it  when  we  become  possessed  with  the 
thirst  of  ambition  or  gain.  "  In  every  man  there  is  born 
a  poet  who  dies  young. ' ' 

Fortunate  the  man  who  has  early  acquired  a  taste  for 
landscape  and  color;  or  that  "  taste  for  weather  as  such," 
which  one  New  England  man  claims  to  have  acquired, 
and  who  is  amused  and  pleased  by  the  flora  and  fauna, 
the  rocks  and  the  stars  ;  or  for  whom  some  little  knowl- 
edge of  geology  makes  all  the  ground  a  vast  and  in- 
teresting book,  which  he  who  runs  may  read.  For  a 
nervous  system,  weakened  and  irritated  by  the  experi- 
ences of  city  life,  gardening,  or  the  calm  intellectual 
diversions  of  the  amateur  naturalist,  botanizing,  sketch- 


THE    OUTING   CURE.  IOI 

ing,  collecting,  and  the  walking  and  climbing  which 
they  involve,  are  the  perfection  of  exercise  and  change,  as 
Tyndall's  Hours  of  Exercise  in  the  Alps  was  the  perfec- 
tion of  those  recreations  for  healthy  men. 

' '  The  moral  sensibilities  which  make  Edens  and  Tempes 
so  easily  may  not  always  be  found,  but  the  material  land- 
scape is  never  far  off,"  says  Emerson,  and  many  who 
would  appreciate  and  enjoy  out-of-door  sights  and  sounds 
must  be  taught,  and  must  begin  with  the  primer.  A 
score  of  charming  out-door  books  teach  the  possible  * '  har- 
vest of  a  quiet  eye."  Clarence  King's  Mountaineering  in 
the  Sierra  Nevadas,  and  the  whole  fascinating  literature 
of  mountain-climbing,  Tyndall,  Whymper,  and  the  rest, 
can  hardly  fail  to  inspire  the  most  inappreciative  with  a 
new  interest  in  life.  Before  going  to  the  seaside,  there 
may  be  obtained  any  one  of  half-a-dozen  primers  of  ma- 
rine zoology,  which  will  convert  a  common-place  sea- 
beach  into  a  fairy-land  abounding  with  objects  of  interest 
and  beauty — especially  if  such  a  book  as  Charles  Kings- 
ley's  "  Glaukus  "  happens  to  be  the  one  selected. 

CLIMATE  IN  NERVOUS  IMPAIRMENT. — Experience  shows 
that  certain  nervous  invalids  cannot  hope  to  be  cured  at 
home.  Weather  or  social  environment  hinders,  or  busi- 
ness and  social  cares  will  obtrude.  A  change  is  neces- 
sary, and  the  question  of  climate  becomes  interesting. 
The  climate  cure  of  nervous  impairment  is  a  combination 
cure.  It  includes  rest,  peace,  sleep,  oxygen,  sunshine, 
comfortable  shelter,  suitable  food,  and  (if  any  society  at 
all)  agreeable  society.  This  combination  is  not  common 
from  home,  as  any  traveller  knows. 

The  trip  to  Europe,  the  tour  of  the  great  cities,  or  of 
the  fashionable  watering  places,  and  other  trips  involving 
much  railroading,  which  many  nervous  invalids  begin  to 
plan  at  once  when  change  is  advised,  are  not  permissible. 
The  excitements  of  travel  act  as  stimulants,  and  may 
cause  one  to  feel  better  for  a  time,  but  the  sight-seeing  is 


IO2  NERVE    WASTE. 

generally  overdone;  the  expenditure  of  nerve-force  is 
kept  up,  and  no  permanent  benefit  is  obtained. 

In  general,  it  may  be  said  that  any  climate  which  is 
good  for  the  consumptive  is  good  for  the  nervous.  The 
great  remedy  in  lung  trouble,  pure,  .equable,  balmy  air, 
is  also  a  great  remedy  in  nervous  impairment. 

Where  choice  is  to  be  had  I  prefer  the  sea-coast. 
There  is  something  in  the  salt,  inoist  ocean  atmosphere 
that  both  soothes  and  braces.  An  hour  of  walking  in 
the  thick,  salt  night-fog,  which  occurs  at  certain  seasons 
in  San  Francisco,  is,  one  gentleman  finds,  the  most  effi- 
cient hypnotic  in  his  case.  Indeed,  the  opposite — high, 
dry  climate — seems  to  produce  nervousness.  I  not  rarely 
see  men  from  the  high  altitudes  of  Colorado,  Arizona 
and  other  places,  whose  nervous  symptoms  cannot  be 
traced  to  any  other  cause  than  the  prolonged,  over-stim- 
ulating influence  of  their  climate.  A  few  months  of  resi- 
dence at  the  coast  almost  invariably  benefits  these  cases, 
and  they  often  feel  better  from  the  first  day.  The  choice 
of  climate  is  best  made  for  any  individual  by  the  physi- 
cian who  knows  him  best  ;  but  whether  he  gets  his 
oxygen  and  sunshine  from  sea  air,  with  its  medication  of 
sea-salts  and  iodine,  or  from  the  balsamic  ozone-laden  air 
at  the  mountains,  benefit  will  be  likely  to  result, 

Of  old  world  climates,  Madeira,  the  Riviera,  and 
the  Mediterranean  health  resorts  generally  may  be  in- 
stanced as  suitable  climates  for  nervous  impairment, 
though  a  place  which  is  famous,  and  has  a  vogue  is  not 
one  I  should  select  for  an  over-worked  patient. 

Dr.  Hutchinson,  in  a  valuable  paper  on  "Climate  Cure 
in  Nervous  Diseases"  (N.  Y.  Medical  Record,  1879), 
then  stated  that  the  Bermudas,  the  Bahamas,  and  the 
Windward  islands  are  the  most  available  winter  climates 
for  residents  of  the  Eastern  United  States. 

The  mild  and  equable  climate  of  California,  in  permit- 
ting a  full  and  continuous  use  of  out-of-doors  as  a 


THE   OUTING    CUBE.  103 

remedy,  is  as  valuable  to  the  nervous  as  to  the  consump- 
tive. Especially  is  this  true  of  the  coast  region  from 
L,ake  and  Sonoma  counties  to  San  Diego. 

San  Francisco  has  some  claims  to  being  a  winter  city. 
Its  mean  annual  temperature  ranges  between  52°  and 
60. °  Its  winter  is  pleasanter  than  its  summer;  and  three 
of  its  months,  between  August  and  December,  are  al- 
most perfect — free  from  wind,  fog  and  rain,  which  are 
liable  at  some  other  times,  and  from  heat  and  cold,  which 
are  never  known.  For  residents  of  the  interior,  in  winter, 
this  city  with  its  miles  of  dry  sidewalks,  its  cable  cars, 
and  the  innumerable  mental  diversions  to  be  found 
therein,  make  it  a  good  place  to  seek  a  change  of  cli- 
mate. The  city  is  a  delightful  play -ground,  though  it  is 
apt  to  be  a  hard  workshop. 

The  Santa  Cruz  region,  forty  to  seventy  miles  due 
south  of  San  Francisco,  is  all  that  can  be  desired.  From 
Pescadero  to  Monterey  many  a  sandy  beach  stretches  at 
the  feet  of  a  landscape,  picturesque  or  beautiful,  a  region 
restful  and  invigorating.  In  the  Santa  Cruz  mountains 
one  finds  an  exquisitely  clear  atmosphere,  where  the 
smell  of  the  sea  is  mingled  with  the  spicy  fragrance  of 
the  redwoods,  and  where,  within  the  radius  of  a  few 
miles,  a  great  variety  of  charming  scenery  encourages 
the  stranger  to  walk  or  climb. 

The  Santa  Barbara  and  Ventura  region  is  one  of  the 
halcyon  spots,  not  alone  of  California,  but  of  the  world. 
Such  a  combination  of  ever-blue  ocean,  ever-blue  sky, 
hard,  sandy  beaches,  mountains  full  of  character,  pictur- 
esque canons  and  road-bits,  and  perennial  fine  weather 
must  be  rare  on  earth. 

Santa  Barbara,  now  a  town  of  5,000  people,  lighted  by 
electricity,  and  affording  several  first-class  hotels,  and 
unique  in  its  large  proportion  of  cultured  gentlefolk,  lies  in 
a  nook  open  to  the  sea,  and  is  a  trifle  less  uniformly  mild 
than  Pasadena  for  instance.  But  the  early  morning  fogs 


104  NERVE    WASTE. 

and  the  mild  winds,  which  sometimes  occur  at  Santa 
Barbara,  are  an  advantage,  rather  than  a  drawback  to 
the  nervous.  For  probably  three  hundred  days  or  more 
in  the  year  Santa  Barbara  nestles  between  ocean  ex- 
panse and  mountain  height,  as  perfect  a  haven  of  rest  as 
humanity  has  any  need  of,  or  right  to.  In  the  health 
resources  of  its  vicinage,  in  the  tempting  and  varied  ex- 
cursions which  its  back  country  affords,  Santa  Barbara  is 
for  the  nervous,  perhaps,  the  most  desirable  objective 
point  in  the  South.1 

The  whole  South  is  a  natural  vacation-land,  and  the 
people  who  possess  it,  realizing  this  fact,  have  gone  ex- 
tensively into  the  way  of  entertaining.  Klegant  (and 
better  still),  comfortable,  clean  and  moderately  expensive 
hotels  abound. 

The  Sandwich  Islands,  eleven  in  number,  two  thou- 
sand miles  and  seven  or  eight  steamer-days  from  San 
Francisco,  are  perfect  sanitaria  for  certain  cases  of  over- 
work and  worry.  The  mean  temperature  of  these  islands 
is  about  75°,  the  thermometer  varying  between  90°  and 
60°,  and  falling  to  40°  on  the  mountains.  The  moist, 
balmy,  regular  climate,  while  somewhat  relaxing  for  a 
permanent  residence,  is  perfectly  adapted  for  a  few  weeks 
or  months  of  brain-and-spine  rest.  Packet  steamers  and 
small  schooners  ply  between  the  islands,  and  the  ascent  of 

IA  little  work,  "Santa  Barbara  and  Around  There,"  by  Edwards  Roberts, 
(Boston,  1886),  perfectly  suggests  the  charm  of  this  earthly  paradise.  See  also 
Harper's  Magazine,  November,  1887,  for  some  admirable  illustrations. 

The  charm  of  out  of  doors  in  California  has  inspired  some  agreeable  books. 
"Southern  California,"  by  Theodore  S.  Van  Dyke  (New  York,  1886),  is  more 
appropriately  shelved  with  Thoreau,  Burroughs  and  Kingsley  than  among 
the  guide-books,  though  as  a  guide-book  it  is  admirable.  The  people  of  the 
South  can  never  be  over-grateful  to  the  memory  of  Mrs.  Jackson,  whose 
"Ramona,"  among  other  writings,  realized  and  vivified  the  traditions  of  a 
land  where  tradition  alone  is  lacking.  "California  of  the  South,"  by  Drs. 
lyindley  and  Widney,  (New  York  1888),  has  peculiar  value  for  invalids  in  that  it 
is  the  work  of  physicians  who  are  long  residents  of  that  land.  Admirers  of 
Mr.  Stevenson  will  remember  his  "Silverado  Squatters"  (to  come  north). 
Some  of  the  best  descriptions  of  vacation  California  have  been  swept  out  of 
sight  in  the  swift  current  of  periodical  literature. 


THE    OUTING    CURE.  IO5 

the  volcanoes  (ten  thousand  to  fourteen  thousand  feet 
high)  affords  an  exciting  break  in  the  monotony  of  life  on 
a  trade-wind  island. 

There  is  much  to  be  said  for,  and  some  things  against 
a  long  sea  voyage.  In  the  rest  that  it  enforces,  in  the 
absolute  isolation  from  care,  and  from  temptation  and 
goading  to  work,  or  dissipation  of  any  kind,  and  in  the 
ocean  air  and  change  of  air,  it  is  good.  In  that  stormy 
weather  and  the  exigencies  of  sea-life  may  necessitate  con- 
siderable imprisonment  in  an  ill- ventilated  cabin,  and  in 
the  poorer  food  supply,  it  is  not  so  good.  One  is  more 
dependent  upon  luck  in  a  sea  voyage  than  he  would  be 
ashore.  Still,  there  are  cases  where,  all  things  con- 
sidered, a  long  sea  voyage  is  best.1 

Seeking  health  away  from  home  has  its  drawbacks. 
Some  men  are  everywhere  at  home;  they  are  citizens  of 
the  world;  they  easily  make  acquaintances  and  enjoy 
themselves.  Others,  retiring  by  nature,  or  inelastic  from 
sickness,  grow  homesick  and  depressed,  mope,  worry, 
and  remain  unbenefited  in  the  most  perfect  climate.  An 
invalid  should  leave  home  in  company,  if  possible,  and 
cannot  come  to  his  destination  with  too  many  letters,  or 
too  many  preparations  for  quiet  amusement.  One  whose 
life  is  supposed  to  be  in  the  slightest  danger  from  any 
disease,  should  hesitate  long  before  venturing  far  away 
from  home  alone. 

iThe  Ocean  as  a   Health  Resort,  by  Wm.  S.  Wilson  ^  Philadelphia,  1880),  is 
an  admirably  thorough  and  instructive  hand-book. 


XX 

BRAIN    AND    NERVE    FOODS 

Chemical  analysis  shows  that  the  brain  is  composed 
chiefly  of  water,  fat,  albumen  and  phosphorus.  The  nu- 
trition of  brain  and  nerve  tissue  may  be  analyzed  into 
three  elements:  First,  the  food;  second,  the  digestion 
of  it;  third,  the  picking  up  from  the  blood  by  the  brain 
and  nerve  tissues  of  those  substances  which  they  require — 
the  assimilation  of  it.  Thus  the  mere  swallowing  of  any 
substance  is  at  most  only  one-third  of  the  way  to  brain 
and  nerve  feeding. 

When  the  cells  of  the  nervous  system  become  weakened 
from  any  cause,  this  weakness  involves  their  whole  physio- 
logical life.  Not  only  is  their  function  of  giving  out  force 
impaired,  but  their  power  of  attracting  and  appropriating 
nourishment  from  the  blood-current  is  also  impaired. 
The  vigorous  young  nerve-cells  of  a  country  boy  will  ex- 
tract from  even  a  poor  diet  an  abundance  of  nerve-force, 
which  is  exhibited  in  his  firm  flesh,  toned  muscles  and 
tireless  activity.  The  enfeebled  nerve-cells  of  an  aged 
millionaire  cannot  extract  from  the  most  succulent  and 
nutritious  diet  a  similar  amount  of  force;  his  flesh  is 
flabby,  his  muscles  unsteady  and  his  powers  limited.  In 
many  bald-headed  men  the  blood-stream  is  of  the  richest 
quality,  but  the  debilitated  hair  follicles  are  unable  to 
make  hair  from  it. 

This  may  serve  to  illustrate  why  nervous  invalids  de. 
rive  no  great  benefit  from  preparations  of  phosphorus  and 
substances  supposed  to  be  "  nerve-foods. ' '  If  these  drugs 
were  far  more  nutritious  than  they  really  are,  and  if  the 
blood  of  the  man  with  weakened  nerve-cells  were  loaded 
with  phosphorus,  benefit  would  not  necessarily  result. 

(106) 


BRAIN   AND   NERVE    FOODS.  lO/ 

The  weakened  nerve-cells  can  only  assimilate  a  limited 
quantity  of  phosphorus,  and  when  this  substance  is 
brought  to  them  in  unusual  amount  by  the  blood,  it  is 
unused,  carried  away  again  and  excreted  from  the  system. 

The  brain  and  nerves  feed  upon  the  blood,  and  a  rich, 
pure  blood,  well  charged  with  oxygen,  is  the  best  nerve- 
food.  This  quality  of  blood  is  best  made  from  natural 
foods;  it  is  hard  to  improve  upon  the  Creator's  method  of 
blood-making. 

Whenever  the  reader  feels  that  he  needs  a  nerve-food, 
the  wisest  thing  he  can  do  is  to  put  himself  in  the  hands 
of  his  physician,  but  if  he  is  not  quite  wise  enough  for 
this,  some  suggestions  will  be  of  value  to  him. 

A  full  daily  supply  of  out-door  air  is  of  the  first  im- 
portance in  brain  and  nerve  feeding.  This  oxygen  must 
be  taken  every  day,  and  the  more  the  better,  for  it  is  one 
of  the  few  remedies  that  is  not  apt  to  be  abused.  If  the 
reader  have  no  respect  for,  nor  confidence  in  a  remedy  so 
cheap  and  simple,  the  oxygen  can  be  had  of  certain  manu- 
facturers in  rubber  bags  at  so  much  per  gallon.  This 
roundabout  way  of  using  oxygen  is  not  nearly  so  effica- 
cious in  nervous  exhaustion  as  the  out-door  plan,  but  it 
seems  to  suit  some  persons  better.  L<est  I  be  suspected  of 
being  more  enthusiastic  than  sound  upon  this  subject,  I 
will  attempt  to  explain,  briefly,  the  relationship  which 
exists  between  oxygen  and  nerve  nutrition;  to  make  this 
explanation  complete  necessitates  the  repetition  of  a  state- 
ment, but  repetition  is  said  to  be  one  of  the  essentials  of 
good  teaching. 

i .  Oxygen  is  the  most  efficacious  known  tonic  for  the 
nervous  tissues  ;  it  comes  into  direct  contact  with  the 
brain  and  nerve-cells,  vivifies  them,  and  helps  them  to 
help  themselves  ;  by  improving  the  vigor  of  the  nerve- 
cells  it  improves  the  digestive  power  which  depends  upon 
these  nerve-cells,  and  thus  insures  a  better  quality  of 
blood. 


IO8  NERVE    WASTE. 

2.  The  reduction  of  food  in  the  stomach  and  intes- 
tines to  a  liquid  is  not  the  whole  process  of  blood-making. 
Before  this  nourishing  fluid,  chyle,  reaches  the  general 
circulation  a  large  part  of  it  must  pass  through  the  liver, 
where  it  is  subjected  to  some  important  modifications. 
Of  this  food-stream,  the  starches,  sugars  and  alcohol  are 
partially  burned  up — by  chemical  union  with  the  oxygen 
of  the  blood — they  are  oxidized,  and  in  this  process 
animal  heat  is  evolved;  we  have  alreaded  noted  that  heat 
is  convertible  into  nerve-force.  The  peptones,  which 
represent  the  more  hearty  foods,  the  meats,  etc.,  are 
also  subjected  to  the  action  of  oxygen.  These  nitro- 
genous foods,  or  peptones,  are  usually  eaten  in  larger 
quantities  than  the  body  has  any  need  of,  and  one  of  the 
uses  of  oxygen  in  the  body  is  to  dispose  ol  this  surplus — 
to  so  change  it  that  it  can  be  excreted  from  the  system. 
It  does  this  by  oxydizing  the  excess  of  meat-food,  and 
gradually  converting  it  into  a  substance  called  urea. 
This  urea,  the  product  of  perfect  oxidation,  is  unirritat- 
ing  and  soluble  in  the  blood,  and  thus  is  able  to  be  fil- 
tered out  through  the  kidneys  without  injury  ;  the  urine 
is  largely  a  solution  of  urea.  When  the  amount  of  oxy- 
gen in  the  blood  is  not  proportionate  to  the  amount  of 
food,  either  as  a  result  of  sedentary  habits  or  of  over- 
eating, or  of  both  together,  this  process  of  oxidation  is 
imperfect;  the  resulting  waste  substances  fall  short  of 
urea;  they  are  more  irritating;  they  are  not  very  soluble 
in  the  blood,  and  hence  are  not  easily  removable  by  the 
kidneys.  In  short,  they  act  as  unnatural  and  poisonous 
substances  in  the  blood.  These  abnormal  products  of 
imperfect  oxidation  are  known  as  uric  acid,  lithic  acid 
and  oxalic  acid,1  and  the  condition  in  which  they  are 


1  Strictly  oxalic  acid  does  not  exist  in  the  blood.  It  is  formed  in  urine  (whether 
in  the  urinary  passages  or  outside  the  body)  by  the  decomposition  of  uric  acid 
and  the  urates,  or  by  that  of  oxaluric  acid  (which  is  oxidized  lithic  acid)  into 
oxalic  acid  and  urea.  Thence  oxalate  of  lime  and  "  oxaluria." 


BRAIN  AND  NERVE  FOODS.  IOQ 

present  in  the  blood  is  called  lithsemia,  or  lithiaisis,  and 
is  at  the  bottom  of  some  of  the  gravest  diseases.  , 

These  substances  may  assist  to  form  an  abnormal  and 
excessive  quantity  of  bile  —  ' {  biliousness, "  ' '  bilious 
colic;"  they  may  be  laid  down  in  the  joints  or  attack 
almost  any  tissue  in  the  body — gout ;  they  may  irritate 
and  eventually  cause  disease  in  the  blood-vessels  through 
which  they  are  borne — apoplexy,  aneurism  ;  they  may 
irritate  and  set  up  a  chronic  inflammation  of  the  kidney 
— Bright' s  disease  ;  they  may  form  collections  in  the 
urinary  passages — stone  in  the  bladder 

Nervous,  overworked  men  are  often  great  consumers 
of  meat  ;  they  eat  it  by  instinct  to  repair  the  waste  of 
excessive  work.  When  such  a  man  spends  most  of  his 
time  indoors,  breathing  with  only  the  upper  half  of  his 
lungs,  his  oxygen  supply  is  not  likely  to  be  great  enough 
for  perfect  excretion,  and  he  may  eventually  suffer  from 
some  of  the  various  forms  of  lithaemia. 

There  is  a  class  of  people  who  are  not  nervous,  in 
whom  a  rich  diet,  a  poor  oxygen  supply,  and  a  free  use 
of  alcoholic  drinks  sooner  or  later  produce  some  of  the 
graver  forms  of  lithaemia — most  often  Bright 's  disease. 
Alcohol  uses  up  oxygen  very  quickly,  and  leaves  little 
behind  to  attend  to  the  oxidation  of  surplus  meat  foods, 
and  in  addition,  alcohol  is  itself  irritating  to  the  kidneys, 
liver  and  blood-vessels.  L,ithaemia  in  some  of  its  forms 
is  the  national  disease  of  the  beef-eating  and  spirit-drink- 
ing gouty  Englishman,  as  neurasthenia  is  the  national 
disease  of  the  over-worked,  neurotic  American. 

But  no  theory  or  science  is  needed  to  convince  us  of 
the  value  of  oxygen  in  nerve-feeding  if  we  will  recall  our 
experience.  Most  of  us  know  that  we  can  eat,  digest, 
and  use  up  a  much  larger  amount  of  food  when  our  days 
are  spent  in  the  open  air,  than  when  they  are  spent  in  a 
stuffy  office  or  workshop. 


110  NERVE    WASTE. 

Coming  now  to  actual  foods,  the  fats  stand  highest  on 
the  list  for  the  nervous — cream,  fresh  butter,  the  fat  of 
roast  beef  and  of  beefsteaks ;  the  brain  is  rich  in  fatty 
substances,  and  fat  goes  to  make  heat  and  force.  Fats, 
while  highly  nutritious  to  the  nerves,  are  not  so  easily 
digested  as  lean  meat,  but,  by  keeping  up  his  oxygen, 
the  nervous  invalid  will  find  himself  able  to  manage 
more  and  more  of  these  substances. 

Cod-liver  oil  is  the  most  valuable  nerve-food  when  it  can 
be  managed  by  the  digestive  organs.1  I  prefer  the  plain  oil 
to  any  of  the  numerous  emulsions  and  compounds.  Taken 
in  ' (  sandwich  ' '  cod-liver  oil  is  not  in  the  least  disagree- 
able to  swallow.  Fill  a  small  glass  two-thirds  full  of 
beer,  moisten  the  sides  to  the  brim  by  a  rotary  motion  of 
the  glass,  float  the  oil  on  the  top  of  the  beer,  cover  with 
an  inch  of  froth.  Thus,  the  oil  may  be  tossed  off  without 
ever  coming  in  contact  with  the  sides  of  the  glass,  or  the 
tongue  or  the  throat,  and  without  being  tasted.  Another 
method  of  swallowing  oil  without  tasting  it  is  to  pour  a 
tablespoonful  of  beer  into  the  bottom  of  a  glass,  then 
add  the  oil,  then  pour  half  a  glass  of  beer  upon  the  oil 
from  a  height,  and  toss  off  the  perturbed  contents,  as 
one  remarked,  ' '  before  the  oil  knows  where  it  is. ' '  The 
beer  is  a  valuable  addition,  as  it  assists  the  stomach  to 
manage  the  oil ;  it  is  not  rare  to  see  nervous  persons  gain 

*A  drawback  to  the  use  of  cod-liver  oil  is  the  difficulty,  or  rather  the  uncer- 
tainty, of  getting  a  pure  oil.  Cod-liver  oil  is  as  variable  in  quality  as  butter. 
Where  the  oil  is  made  from  putrefying  livers,  by  dirty  workmen,  in  dirty  uten- 
sils, it  is  as  certain  to  be  rancid  as  is  butter  made  under  similar  circumstances. 
The  author  has  been  informed  that  "  cod-liver  oil  "  is  made  on  a  large  scale  by 
soaking  burnt  herrings  in  various  cheap  oils.  A  rancid  or  a  spurious  oil  is 
likely  to  do  as  much  harm  as  a  pure  oil  is  to  do  good.  Among  the  oils  which 
maybe  relied  upon  are  "Burnett's,"  marketed  by  T.  Metcalf  &  Co.,  of  Boston, 
"Marvin's,"  by  John  Wyeth  &  Co,  of  Philadelphia,  "Peter  Holler's,  and 
Allan  &  Hanbury  s,  an  English  oil.  The  dose  of  cod-liver  oil  should  not  be 
too  large,  especially  on  beginning.  The  "tablespoonful"  advised  by  many 
manufacturers  and  druggists  is  injudicious.  I  generally  begin  with  ten  drops, 
and  gradually  increase  to  a  dessert-spoonful  three  times  a  day.  In  most  cases 
there  is  no  advantage  in  going  beyond  the  latter  dose.  I  have  begun  with  three 
dre^s  where  the  stomach  did  not  take  kindly  to  the  oil. 


BRAIN   AND    NERVE    FOODS.  Ill 

five,  or  even  ten  pounds,  in  a  few  weeks,  on  this  oil  and 
beer. 

Children  of  nervous  parents  may  be  given  a  semi-annual 
course  of  cod-liver  oil  from  early  childhood  to  through 
puberty  with  great  benefit ;  it  improves  the  nutrition  and 
development  of  the  nervous  structures  and  to  a  great 
extent  insures  stability;  it  is  putting  nerve-force  in  the 
physiological  savings  bank.  Cod-liver  oil  and  out-of-door 
life  would  convert  many  a  thin  peevish  child  into  a 
sturdy,  steady  one. 

There  is  probably  nothing  subtle  or  specific  about  cod- 
liver  oil;  it  is  simply  the  most  assimilable  form  of  fat,  and 
when  it  does  not  agree  it  is  best  avoided;  then  cream  is 
the  next  best  nerve-food.  The  breakfast  coffee  may  be 
made  a  valuable  nerve-food  to  most  persons.  To  a  half 
or  a  third  of  a  cup  of  pure  fresh  cream  add  coffee  hot 
enough  and  strong  enough  to  bear  the  dilution  without 
making  the  drink  cold  and  weak.  This  makes  a  rich, 
smooth,  elegant  beverage,  which  is  superior  in  restora- 
tive power  to  a  whole  bottle  of  hypophosphites.  The 
cream  excuses  the  coffee,  the  coffee  helps  the  digestive 
organs  with  the  cream,  and  many  persons  who  ' '  cannot 
drink  coffee ' '  can  drink  this  coffee-cream  with  benefit. 
Dinner  may  be  terminated  by  a  small  cup  of  hot  coffee — 
one-third  each  of  cream,  milk  and  coffee.  The  breakfast 
cereals  may  be  enriched  with  cream;  potatoes  may  occa- 
sionally be  served  ' '  mashed  ' '  with  milk  and  cream  ; 
many  ripe  fruits  will  not  quarrel  with  cream  ;  in  winter 
ripe  bananas  and  cream  make  a  delicious  dessert ;  ice- 
cream— home  made  with  fresh  strawberries,  may  be  per- 
mitted to  some  as  a  dissipation. 

Cocoa  seeds,  as  variously  prepared  by  different  manu- 
facturers, are  a  useful  addition  to  the  dietary  of  nervous 
invalids.  These  seeds  contain  nearly  fifty  per  cent,  of  &, 
fixed  oil  or  fat,  besides  an  alkaloid,  theobromine,  which 
is  analagous  to  the  caffeine  of  coffee;  burning,  develops 


112  NERVE    WASTE. 

an  agreeable  aroma,  and  when  ground  into  a  paste  and 
mixed  with  various  flavors,  we  have  chocolate.  Choco- 
late is  too  rich  in  fat,  and  thus  too  heavy,  for  most  nervous 
persons,  although  highly  nutritious. 

Baker's  breakfast  cocoa  is  a  light  preparation  which 
can  be  heartily  recommended;  it  contains  only  so  much 
fat  as  can  be  digested  by  almost  anyone;  and  is  peculiar 
in  not  cloying  or  palling  after  a  time,  as  so  many  cocoa 
preparations  do.  Such  a  beverage  is  far  more  wholesome, 
and  more  agreeable,  after  one  becomes  used  to  it,  than 
tea,  which  is  so  much  over-used.  It  is  especially  useful 
for  children;  our  little  boy  has  drunk  it  since  he  was  a 
year  and  a  half  old,  has  become  inordinately  fond  of  it, 
and  has  kept  as  ' '  fat  as  a  pig, "  as  we  say. 

All  these  liquid  preparations  serve  a  very  useful  pur- 
pose in  cases  of  nervous  impairment  where  the  digestion 
is  weak.  Belchings,  slow  digestion,  sour  risings,  heavy 
sensations  or  pain  in  the  stomach,  are  plain  signs  that 
solid  food  ought  to  be  sparingly  taken  or  withdrawn 
altogether.  They  indicate  that  the  digestive  juices  are 
too  poor  in  quality  to  properly  disintegrate  and  reduce 
masses  of  more  or  less  solid  food  to  liquid  chyle.  Hot 
bouillon  (which  some  cooks  flavor  deliciously  with  a 
little  celery  and  spinach)  is  a  good  thing  for  such  persons. 
When  a  man  comes  to  his  luncheon  without  an  appetite} 
or  to  his  dinner  too  tired  to  eat,  and  yet  feels  that  he 
needs  something  to  ' '  stay  his  stomach, ' '  one  of  the  best 
things  he  can  do  is  to  take  a  plate  of  hot  bouillon  and  a 
little  bread,  and  nothing  else.  In  many  cases  of  nervous 
indigestion  the  immediate  symptoms  may  be  quickly 
removed  by  limiting  the  patient  for  a  few  days  to  hot 
bouillon  and  bread  as  often  a  day  as  he  wishes  it.  A 
plate  of  hot  bouillon,  with  or  without  a  little  bread,  at 
bedtime,  is  effectual  in  many  cases  of  sleeplessness;  a 
glass  of  milk,  warm  and  slightly  sweetened,  will  favor 
sleep  and  increase  weight.  . 


BRAIN   AND   NERVE    FOODS.  113 

Koumyss — sparkling  milk,  milk  in  which  fermentation 
has  been  induced — is  a  valuable  food  in  many  cases. 

The  neurasthenic  can  hardly  eat  too  much  fresh,  sweet 
butter  ;  it  may  be  swallowed  in  large  quantities  with  warm 
corn-bread;  upon  soft-boiled  eggs;  in  mashed  potatoes. 

Next  in  value  to  the  fats  are  the  unbolted  cereals;  first 
of  all,  wheat,  then  oats  and  corn.  Cracked  wheat  and 
cream  is  an  ideal  nerve-food.  The  preparation  known 
as  ''Aunt  Abbie's  rolled  oats  "  is  easily  cooked  and  alto- 
gether excellent.  Corn-bread,  the  "  johmry-cake "  of 
New  Kngland,  made  of  corn  meal,  eggs  and  flour,  thick, 
light,  warm  and  soaked  with  fresh  butter,  is  a  better 
nerve-food  than  can  be  found  on  the  druggists'  shelves. 
Though  highly  nourishing,  cereals  are  not  the  most 
easily  digestible  of  foods,  and  even  prove  too  coarse  and 
irritating  for  a  few  stomachs.  Some  children  who  are 
forced  to  eat  oatmeal,  because  of  its  reputation  as  a 
healthy  food,  suffer  from  indigestion  and  skin  eruptions, 
and  recover  when  the  too  coarse  food  is  withheld.  The 
digestibility  of  cereals  can  be  greatly  increased  by  care- 
ful cooking. 

Roast  beef  and  juicy  steaks  are  rich  in  the  elements  of 
brain  nutrition,  the  phosphates  of  lime  and  soda,  and  the 
fats,  "besides  yielding  a  larger  amount  of  force  to  the 
mouthful  than  any  other  food.  The  preparations  of  phos- 
phorus that  are  put  up  by  the  Creator  in  such  inimita- 
ble packages,  in  the  germ  of  wheat,  oats  and  corn,  and 
in  meats,  have  great  advantages  over  the  artificial  pro- 
ducts of  the  laboratory;  they  are  more  easily  soluble  in 
the  digestive  juices,  and  more  easily  assimilated  by  the 
tissues,  because  they  are  natural.  Fresh  fish  and  shell  fish 
are  light,  easily  digested  foods — when  properly  cooked — 
but  they  have  no  special  value  as  brain  and  nerve  foods. 
Celery,  it  may  be  remarked,  since  the  physician  is  often 
asked  concerning  it,  has  no  value  whatever  in  nerve- 
nutrition,  but  boiled  celery,  served  immersed  in  milk  and 


114  NERVE    WASTE. 

butter,  is  another  thing  ;  L,ima  beans  have  a  high  nu- 
tritive value,  and  may  be  served  in  the  same  way.  The 
man  with  any  stomach  at  all  who  cannot  make  brain  and 
nerve  tissue  and  force  upon  the  diet  I  have  indicated,  will 
not  be  likely  to  find  it  in  any  product  of  the  chemist's 
skill;  but  I  again  insist  that  the  food  supply  must  be 
sustained  by,  and  proportionate  to,  a  proper  oxygen 
supply  It  would  never  do  for  an  indoor  neurasthenic  to 
attempt  this  diet,  in  whole;  and  when  rainy  weather  or 
other  cause  keeps  the  outdoor  one  indoors,  he  must  come 
down  to  sedentary  diet. 


One  of  the  most  difficult  things  to  find,  away  from  home,  is  wholesome,  well- 
cooked  food.  Some  of  my  neurasthenic  patients,  though  living  in  elegant 
hotels,  have  not  been  able  to  get  enough  to  eat.  When  the  homeless  neuras- 
thenic finds  a  table  where,  the  following  bill  of  fare  may  be  selected,  among 
other  things,  he  is  advised  to  cherish  it  : 

Breakfast. — Fruit  in  season,  baked  apples,  stewed  prunes;  coffee-cream, 
well-cooked  cracked  wheat  and  cream,  rolled  oats  and  cream,  corn  bread  and 
fresh  butter  ^two  butters  for  one  bread),  soft-boiled  eggs,  fresh  butter  ad 
libitum, 

Luncheon.— Chicken  soup,  hot  bouillon,  bread;  properly  made  breakfast 
cocoa;  fresh,  warm  sweet  milk  ad  libitum',  raw  oysters,  beer,  bread. 

Dinner.— Soup,  roast  beef,  broiled  porterhouse  steak,  mashed  potatoes  (made 
with  butter,  milk  and  cream),  stewed  celery,  stewed  fresh  lima  beans,  bread, 
fresh  butter  ad  capacitatem,  claret,  sauterne  or  burgundy,  ripe  bananas  and 
cream,  custard  and  preserved  raspberries,  ice  cream— home  made  of  pun 
cream — and  fresh  strawberries  (rarely),  small  coffee-cream. 

Supper  (night-cap  for  certain  cases) .—Breakfast  cocoa,  bread;  hot  bouillon, 
bread;  sweet  milk;  raw  oysters,  beer,  bread. 

The  neurasthenic  will  do  well  to  confine  himself  to  the  wholesome,  nour- 
ishing solid  dishes  and  not  dissipate  his  digestive  pqwer  upon  greasy  fish,  meats, 
gravies  or  entrees,  or  upon  dessert. 


XXI 

TEA,    COFFEE,    TOBACCO,    AND    ALCOHOL. 

Concerning  these  substances  it  is  not  possible  to  make 
one  rule  for  the  whole  human  race  ;  used  temperately 
they  add  a  great  deal  to  the  comforts  of  life;  used  intem- 
perately  they  may  create  great  mischief ;  thus  a  danger 
lurks  in  their  moderate  use.  Coffee  and  tea  are  both 
stimulants  to  the  nervous  system,  and  their  habitual  use 
probably  increases  the  sensitiveness  of  the  nervous  tis- 
sues; used  intemperately  these  substances  may  induce  a 
high  degree  of  "  nervousness,"  manifested  in  trembling 
fingers,  palpitations,  disordered  vision,  or  indigestion. 

A  habit  of  excessive  tea  drinking  may  be  gradually 
displaced  by  sipping  hot  water  barely  flavored  with 
orange  peel,  or  lemon  juice,  or  any  agreeable  substance. 
When  tea  is  drank  for  its  stimulative  effect  more  than 
for  sociability,  very  hot  milk  or  breakfast  cocoa  may  be 
substituted. 

TOBACCO  in  small  quantities  is  a  stimulant  to  the  ner- 
vous system  of  the  habitual  smoker;  it  promotes  the  flow 
of  ideas,  increases  digestion  and  circulation  by  its  stimu- 
lant effect  upon  certain  nerve-centers  in  the  brain,  and  it 
slows  the  processes  of  tissue  waste.  Used  in  excess  it 
becomes  an  irritant  to  the  nerve-centers  ;  the  heart  may 
become  irritable,  the  digestion  may  fail,  the  eyes  may  be- 
come weakened,  and  trembling  fingers  betray  the  irri- 
tated and  weakened  condition  of  the  nerve-cells  within  ; 
1 '  tobacco  amblyopia, "  ' '  smokers  vertigo, "  ' '  smoker's 
heart,"  are  constantly  used  terms  in  medical  practice. 
Gently  rubbing  a  flea-bite  soothes  the  irritated  skin  ;  pro- 
longed scratching  may  destroy  it,  or  set  up  an  inflammatory 


Il6  NERVE    WASTE. 

skin  disease.  So,  tobacco,  used  in  moderation,  by  its 
gentle  stimulant  effect  counter- irritates  and  soothes  the 
brain  and  nerves  excited  by  the  experiences  of  the  day  ; 
prolonged  or  excessively  used,  it  becomes  an  irritant.  It 
is  one  of  the  principles  of  physiology,  that  persistent  irri- 
tation— over  stimulation — of  any  part  eventually  ends  in 
exhaustion.  The  fact  should  be  remembered,  that  per- 
sons of  a  nervous  constitution,  and  persons  living  a  sed- 
entary, indoor  life,  are  more  susceptible  to  the  action  of 
stimulants  and  narcotics  than  others,  and  that  they  are 
more  liable  to  abuse,  and  to  be  injured  by  them.  With 
respect  to  the  use  of  tobacco  by  children  and  immature 
youths,  there  can  be  but  one  opinion  ;  it  is  an  evil  so 
great  and  so  important  in  its  relation  to  the  public  health 
as  to  justify  its  suppression  by  legislation. 

ALCOHOL  in  small  quantities  is  a  gentle  stimulant  to 
stomach,  heart  and  brain  ;  used  in  excess  it  is  one  of  the 
surest  and  most  efficacious  brain  and  nerve  poisons  that 
we  know. 

Many  conservative  men,  who  have  had  opportunity  of 
observing  the  alcohol  question  from  every  point  of  view, 
believe  that  the  popular  use  of  light  wines  as  food  would 
conduce  to  national  temperance.  However  this  may  be, 
there  is  no  doubt  of  the  value  of  light  wines  in  nervous 
impairment.  Used  wisely,  as  food,  with  meals,  and 
never  as  beverages  between  meals,  one  to  two  gills  of 
pure,  light  wine  warms  the  stomach,  assists  digestion, 
gently  soothes  away  weariness  from  the  tired  brain,  and 
furnishes  in  easily  assimilable  form  the  elements  of  force 
and  heat.  Some  persons  are  offended  at  the  statement 
that  alcohol  is  under  any  circumstances  a  food,  but  phys- 
iology demonstrates  (not  theorizes)  that  it  is.  Truth  is 
truth  whatever  bearing  it  may  have  upon  social  questions, 
and  the  firmest  faith  is  that  which  has  conviction  that 
truth  can  never  be  used  to  injure  mankind. 


TEA,    COFFEE,    TOBACCO,    AND    ALCOHOL.  II 7 

Heretofore,  when  a  pure,  soft,  agreeable,  light  wine 
has  been  indicated,  in  sickness,  the  physician  has  been 
obliged  to  recommend  an  imported  article,  but  I  should 
like  to  call  the  attention  of  medical  men  at  a  distance  to 
some  facts  concerning  the  wines  of  California.  The 
sunny  slopes  of  this  State  produce  grapes  which  are  un- 
surpassed in  any  land.  At  first,  and  for  a  long  period, 
California  wine-growers  lacked  a  science  in  planting,  and 
art  in  making.  Now,  after  years  of  effort  and  loss,  the 
more  intelligent  of  them  produce  light  wines  that  are 
mild,  smooth,  of  agreeable  aroma  and  of  delicate  flavor, 
and  in  case  of  the  red  wines,  of  fine  color.  Certain  speci- 
mens even  have  in  them  much  of  that  velvety  softness 
and  seductive  bouquet  which  crowns  the  wines  of  the 
Gironde.  The  Cabernet,  Cabernet- Sauvignon,  Sauvignon 
Vert,  Gutedel,  Sauterne  and  Riesling,  of  the  best  Cali- 
fornia vineyards,  can  hold  up  their  heads  in  any  com- 
pany. The  Zinfandel,  so  extensively  planted  in  this 
state,  is  a  good  (at  its  best,  excellent),  ordinary  wine,  but 
is  by  no  means  to  be  considered  the  best  that  California 
is  capable  of.  When  a  heavier  wine  is  indicated,  as  it 
sometimes  is  in  elderly  patients,  the  California  Burgundy, 
Port  and  Sherry  will  often  be  found  superior  for  medici- 
nal purposes  to  much  of  that  imported.1 

The  habit  of  drinking  whisky  between  meals  is  a  bad 
one  for  a  healthy  man,  and  is  highly  injurious  to  him 
whose  nervous  system  is  his  weak  part.  Without  con- 
sidering the  irritant  effect  of  the  alcohol  upon  the  delicate 

1  Some  of  California's  early  wines  gave  her  a  reputation  that  is  undeserved  to- 
day. It  is  unfortunate,  too,  that  there  is  still  much  thin,  sour,  astringent, 
bad  "California  wine"  on  the  market.  Some  of  this  has  been  made  from 
unsuitable  grapes,  and  some  unskillfully  from  suitable  grapes;  much  of  it  has 
been  made  from  no  grapes  at  all  in  cellars  far  from  California.  Some  of  Cali- 
fornia's own  sons,  I  regret  to  say,  are  the  worst  enemies  of  her  wine  industry. 
Not  a  few  wine-sellers,  hotel-keepers  and  restauranteurs  find  it  profitable  to 
supply  the  stranger  with  a  wine  that  is  cheap  (to  them)  because  it  is  bad.  The 
California  State  Viticultural  Commission  has  established  a  permanent  exhibi- 
tion at  216  Montgomery  street,  San  Francisco,  where  the  best  vineyard  pro- 
ducts of  the  State  are  to  be  seen  and  tasted. 


1 1 8  NERVE    WASTE. 

stomach  lining  and  liver  tissue,  that  proportion  of  alcohol 
which  escapes  unoxidized  through  the  liver,  in  circulating, 
passes  through  the  finely  organized  brain  and  nerve  tis- 
sues, upon  which  it  exerts  a  distinctly  poisonous  effect. 
Neither  wine  nor  whisky  should  ever  be  used  as  ' '  bracers,'' 
or  stimulants  to  the  nervous  system.  The  plan  of  work- 
ing, or  "keeping  up"  on  stimulants  so  common  is  dis- 
astrous; no  one  can  long  follow  it  without  paying  some, 
often  a  severe,  penalty. 

Many  of  the  patented  preparations,  to  be  found  in  so 
great  variety  in  the  drug-stores,  with  the  seductive  names, 
*  *  tonic, "  ' '  restorative, "  ' '  rejuvenator, "  "  nerve-food, ' ' 
are  simply  stimulants,  alcoholic  or  drug,  and  do  the  harm 
that  all  stimulants  do.  •"  The  ladies'  tipple  "  is  a  phrase 
which  a  recent  writer  has  applied  to  that  omnipresent  and 
taking  mixture — "beef,  iron  and  wine."  The  composi- 
tion of  this  compound  varies  with  the  consciences  of  the 
druggists  who  make  it,  but  it  generally  contains  a  good 
deal  of  wine,  and  a  very  little  of  iron  and  beef.  The 
popularity  of  this  mixture  is  a  good  illustration  of  the 
superstitious  faith  that  people  are  apt  to  put  in  drugs. 
One  would  suppose  that  when  a  man  had  decided  to  take 
beef,  wine  and  iron,  he  would  prefer  juicy  steaks  and 
roasts,  with  a  quality  of  wine  of  his  own  choosing,  and 
the  iron  by  itself;  but  the  mixture  representing  the 
virtues  of  dog-meat  and  cheap  wine,  manufactured  to 
reap  as  great  a  profit  as  possible,  has,  in  his  eyes,  ac- 
quired some  strange  power  in  passing  through  the  hands 
of  the  apothecary. 


XXII 

NERVINES    AND    NERVE    TONICS 

Drugs  do  not  occupy  the  place  in  modern  medicine  that 
they  once  did.  The  development  of  the  scientific  method 
in  observing  and  in  thinking  has  infused  a  skepticism  into 
medicine  as  it  has  in  many  other  departments  of  thought. 
Experienced  and  scientific  men  come  forward  with  such 
subversive  statements  as  that  quinine  is  of  little  value  in 
typhoid  fever,  that  strychnine  never  cured  paralysis,  and 
that  phosphorus  is  worthless  as  a  brain-tonic. 

A  reading  of  some  of  the  standard  treatises  upon  ma- 
teria  medica  might  easily  lead  a  layman  to  suppose  that 
all  diseases  are  curable  or  relievable  by  drugs,  but  the 
chronic  invalid  knows  better.  The  best  medical  thought 
of  to-day  tends  toward  a  less  and  less  use  of  drugs  and  a 
greater  and  greater  reliance  upon  the  healing  power  of 
nature,  when  this  is  encouraged  by  hygiene  and  good 
nursing.  Medical  men  have  come,  or  are  coming,  to  ap- 
preciate that  there  are  many  forces  beside  chemicals  which 
act  upon  a  diseased  organ  or  an  impaired  vitality.  In 
late  years  an  impetus  has  been  given  to  the  study  of  vital 
economy,  of  medical  physics,  of  diet  in  disease,  of  clima- 
tology and  of  nursing,  and  a  system  of  individual  hygiene 
for  individual  diseases  is  being  perfected. 

But  although  drugs  have  been  dethroned  and  degraded, 
they  are  by  no  means  exiled  nor  in  contempt.  They  are 
useful,  often  indispensable.  It  is  only  that  they  are  not 
omnipotent.  They  do  not  so  much  cure  as  assist  to  cure; 
they  are  not  now  the  first  forces  thought  of  by  the  wise 
physician,  nor  the  ones  upon  which  main  reliance  is  placed. 

(119) 


120  NERVE   WASTE. 

In  practice  there  is  a  great  pressure  brought  to  bear 
upon  the  physician  to  use  drugs,  and  many  physicians 
yield  to  this  pressure  against  their  best  judgment.  People 
do  not  understand  curing  without  medicine,  and,  what 
often  influences  the  physician  more,  they  are  not  willing 
to  pay  for  such  treatment.  There  is  a  feeling  that  with- 
out the  prescription  nothing  has  been  done,  and  (will  the 
reader  believe  it)  there  are  persons  who,  even  when  the 
life  of  a  loved  one  is  at  stake,  are  too  selfish,  too  careless, 
or  too  unintelligent  to  carry  out  the  necessary  nursing; 
in  such  cases  the  physician  must  do  the  best  he  can  with 
drugs. 

Drugs  used  in  nervous  impairment  may  be  divided  into 
two  classes — those  designed  to  alleviate  some  symptom 
or  to  have  a  temporary  influence,  and  those  designed  to 
have  a  permanent  effect.  The  first  class  consists  chiefly 
of  stimulants  and  sedatives,  the  second  of  tonics. 

NERVE  STIMULANTS  AND  SEDATIVES. — Many  of  the  symp- 
toms of  nervous  impairment  are  unbearable  or  disagree- 
able, and  are  best  alleviated  at  once.  Pain  and  spasm  are 
always  thus  treated.  A  habit  of  sleeping  may  often  be 
made  to  replace  a  habit  of  sleeplessness  by  a  judicious 
use  of  stimulants,  or  of  sedatives,  and  then  these  serve  a 
beneficent  purpose.  The  feeling  of  fatigue  is  often  so 
disagreeable  and  intolerable  that  we  are  justified  in  tem- 
porarily removing  it.  An  insufficient  liver,  indicated  by 
heavy  urinary  deposits,  may  be  gently  stimulated  until 
the  urine  is  clear.  Thus  the  wise  use  of  stimulants  and 
sedatives  is  very  useful  in  nervous  impairment. 

But  certain  facts  need  to  be  remembered  in  connection 
with  the  use  of  these  drugs.  Pain,  headache,  morbid 
fatigue,  sleeplessness  are  not  diseases  but  symptoms;  they 
are  signals  hung  out  by  a  distressed  brain-and- spine. 
Stimulants  and  sedatives  do  that  which  they  do  quickly 
and  have  no  absolute  lasting  good  effect;  they  are  palli- 
ative, not  curative;  they  temporarily  remove  the  symptom, 


NERVINES   AND   NERVE   TONICS.  121 

but  leave  the  disease;  wisely  used  they  are  a  lesser  evil, 
unwisely  they  may  be  a  greater  evil  than  the  symptom 
which  they  temporarily  remove.  The  chemist  can  tem- 
porarily deodorize  an  offensive  spot,  but  he  knows  that 
removal  of  the  putrefying  organic  matter  is  essential  to 
sanitary  safety.  And  it  is  slovenly  doctoring  to  rest  con- 
tent with  covering  a  symptom  by  a  stimulant  or  a  sedative, 
and  not  dig  about  the  roots  of  it. 

The  first  recommendation  with  respect  to  stimulants 
and  sedatives  is  to  avoid  them  when  possible.  We  have 
all  gotten  into  a  habit  of  resorting  too  quickly  to  these 
things — they  act  so  nicely.  But  the  hereditary  neuras- 
thenic, whose  nervous  system  is  his  weak  point,  and  who 
must  needs  be  doctoring  or  caring  for  it  through  a  long 
life  can  afford  to  take  some  trouble  to  escape  the  tyranny 
of  these  substances.  In  what  has  been  called  "the  most 
sensible  medical  book  ever  written,"  Mr.  Hilton1  has 
dwelt  upon  a  law  of  universal  application — that  pain  ap- 
peals for  rest,  quiet,  peace.  Thus  in  sick  headache  or  in 
neuralgia,  one  should  pause  in  a  whirl  of  excitement  or 
activity  and  temporarily  seek  a  subdued  environment. 
Heat  to  various  points  on  the  surface  will  often  do  all 
that  morphine  will.  Hot  drinks  internally — milk,  cocoa, 
water  or  even  black  coffee  or  hot  weak  whisky  punch — 
are  often  capable  of  doing  all  that  caffeine  or  coca  can. 

Of  stimulants,  caffeine  (the  active  principle  of  coffee), 
coca,  and  its  active  principle,  cocaine,  guarana  powder, 
Indian  hemp  (whence  the  "hasheesh"  of  the  orient),  cam- 
phor, valerian,  and  the  preparations  of  ammonia  are  essen- 
tially brain  stimulants.  The  pupil-dilators,  belladonna, 
hyoscyamus,  stramonium,  and  duboisia,  first  stimulate 
the  spine  and  sympathetic  and  incidentally  relax  spasm 
and  paralyze  secretion.  Of  heart  stimulants  digitalis, 
strophanthus,  sparteine,  lily  of  the  valley  may  all  be  so 

1  Rest  and  Pain,  by  John  Hilton,  F.  R.  S. ;  F.  R.  C.  S. ;  Condon. 


122  NERVE    WASTE. 

gently  used  as  to  be  justly  called  tonics;  coca  and  caffeine 
stimulate  the  heart  through  the  brain. 

Of  sedatives,  alcoholic  liquors,  opium  and  its  alkaloids, 
(morphine,  narceine,  thebaine,  papaverina  and  codeine) 
chloroform,  ether  and  nitrous  oxide  first  temporarily 
stimulate  the  brain  and  then  stupefy  it;  they  are  our 
greatest  medicines  against  pain.  The  bromides,  chloral, 
croton  chloral,  hops  act  directly  upon  the  brain  tissue, 
soothing  it  and  withdrawing  blood  from  it  without  stupe- 
fying. Paraldehyde,  sulfonal,  amylene  hydrate,  urethan 
hypnone,  recent  products  of  the  German  laboratories,  cause 
sleep  by  a  direct  influencing  the  brain  cortex  which  we 
do  not  as  yet  understand.  Antipyrine  and  acetanilide, 
also  produced  in  the  laboratory,  from  aniline,  were  first 
introduced  as  remedies  against  fever,  but  are  now  more 
famous  as  nervous  sedatives;  in  many  cases  of  migraine, 
neuralgia,  insomnia,  the  power  of  these  remarkable  drugs 
is  complete.  The  depressants,  conium,  (the  cup  of  hem- 
lock drunk  by  Socrates), Calabar  bean,  jaborandi,  gel- 
semium  (the  pretty  yellow  jasmine),  aconite,  all  have 
terrible  power.  Hydrocyanic  acid  and  the  cyanide  of 
potassium  paralyze  the  centers  of  life  in  less  time  than  it 
takes  to  tell  it.  Nitrite  of  amyl  inhalations  and  nitro- 
glycerine have  a  power  of  instantly  relaxing  arterial 
tension,  which  serves  a  useful  purpose  in  certain  diseases. 

It  is  an  interesting  fact  that  many  of  the  symptoms  of 
nervous  impairment  are  relieved  by  both  stimulants  and 
sedatives — by  drugs  which  have  a  directly  opposite  action 
upon  brain  and  nerves. 

NERVE-TONICS — A.  tonic  is  a  force  which  tones,  or  acts 
with  some  degree  of  permanence  in  opposition  to  a  relaxa- 
tion and  weakness.  In  a  narrower  sense  it  is  a  medicine 
which  tones.  Tone  is  nerve-force  manifested.  It  maybe 
manifested  in  mental  or  muscular  activity,  or  in  the  con- 
traction of  tightness  of  unstriped  muscular  fibre  or  other 
tissue.  The  brain-and-spine  is  the  ultimate  source  of  all 


NERVINES   AND    NERVE    TONICS.  123 

nerve-force,  and  thus  it  must  be  the  great  objective  point 
in  any  attempt  at  toning. 

The  kindly  forces  of  nature — rest,  sleep,  oxygen,  sun- 
shine, food,  exercise,  cheerfulness — are  incomparably  the 
best  tonics.  Unfortunately,  a  large  proportion  of  nervous 
invalids  are  not  able  to  make  the  best  use  of  natural 
tonics;  they  are  too  expensive;  often  they  are  impossible. 
Thus  certain  artificial  tonics  have  their  place  ;  electri- 
city is  one  of  the  best  of  these  ;  drug  tonics  have  their 
field  of  usefulness,  and  the  doctor  himself  sometimes 
acts  as  a  tonic. 

With  respect  to  the  organs  chiefly  influenced  by  tonic 
treatment,  in  different  cases,  we  speak  of  nerve-tonics, 
voice-tonics,  digestive-tonics,  heart- tonics,  reproductive 
tonics,  blood-vessel  tonics,  tissue  tonics,  but  all  these 
forms  of  toning  are  produced  through  and  by  the  central 
nervous  system. 

TONICS  AND  STIMULANTS. — A  careful  distinction  must 
be  noted  between  a  tonic  and  a  stimulant.  A  tonic  acts 
more  or  less  slowly  in  improving  the  nutrition  of  brain 
and  spine,  and  thus  the  vital  resources.  A  stimulant  acts 
more  or  less  quickly  in  exciting  the  brain  and  spine  into 
increased  activity,  and  after  its  influence  has  passed 
leaves  the  brain  and  spine  no  stronger,  or  less  strong, 
than  before.  A  tonic  may  be  compared  to  a  slow  saving 
of  money  which  accumulates  into  a  bank  account.  A 
stimulant  may  be  likened  to  a  mortgage,  which  procures 
immediately  a  large  sum  of  money,  and  is  thus  highly 
gratifying  in  its  immediate  results,  but  which  has  a  day 
of  accounting.  But  with  careful  financiers  a  loan  is  often 
made  the  means  of  ultimately  increasing  capital,  and 
stimulants  may  be  so  judiciously  used  as  to  permanently 
improve  the  vital  resources.  The  abuse  of  stimulants  is 
one  of  the  sanitary  evils  of  to-day;  their  use  is  a  science 
that  is  too  little  understood  or  managed  even  by  medical 
men. 


124  NERVE   WASTE. 

ARSENIC  is  easily  first  among  nerve-tonics.  For  a  long 
period  it  was  known  that  arsenic  had  an  almost  specific 
power  in  certain  indolent  chronic  diseases  of  the  skin.  Its 
action  was  alterative,  i.  <?.,  it  produced  a  change  in  the 
nntrition  of  the  diseased  tissue,  slowly  tearing  down  old, 
and  slowly  building  up  new  skin,  until  a  healthy  surface 
resulted.  I^ater  it  came  to  be  known  that  arsenic  has  a 
similar  effect  upon  a  brain  and  spine  that  it  has  upon  skin, 
It  slowly  re-creates  by  modifying  nutrition,  by  tearing 
down  and  building  up.  To-day  this  remedy  has  the  con- 
fidence of  neurologists  everywhere  as  the  greatest  of  nerve- 
tonics.  Its  action  is  slow,  and  the  remedy  requires  in 
some  cases  to  be  taken  for  months.  In  some  cases  in 
which  the  action  of  arsenic  is  eventually  the  most  marked, 
no  effect  at  all  is  perceptible  for  two  or  three  months, 
when  all  at  once  the  patient  begins  to  improve  rapidly. 
It  improves  the  appetite  and  digestion  from  the  start.  It 
sometimes  markedly  improves  the  health  of  the  skin,  hair 
and  nails.  While  arsenic  in  small  doses,  wisely  used,  is  one 
of  the  most  beneficient  of  remedies,  in  large  doses,  or  un- 
wisely used,  it  is  a  powerful  poison.  For  this  reason  it 
should  never  be  meddled  with  by  others  than  medical  men. 

There  is  opportunity  for  much  wisdom  in  giving 
arsenic.  The  preparation,  the  special  dose  at  different 
stages,  the  way  of  taking,  the  frequency  and  length 
of  the  intermissions,  are  important  points.  The  physi- 
cian by  wise  management  is  able  to  extend  the  good 
effects  of  the  drug  over  months.  A  patient  is  liable  to 
exhaust  the  power  of  arsenic  in  his  case  in  two  or  three 
weeks,  and  to  poison  himself  beside. 

Nux  VOMICA,  and  its  alkaloid,  STRYCHNIA,  are  the  most 
active  nerve  tonics.  They  stimulate  nutrition  in  nerve- 
tissue,  and  especially  in  the  spine.  As  in  case  of  arsenic, 
strychnia  may  be  so  gently  used  as  to  heal  and  renovate, 
or  so  clumsily  as  to  poison  to  death. 


NERVINES   AND   NERVE    TONICS.  125 

PERUVIAN  BARK,  and  its  alkaloid,  QUININE,  is  a  power- 
ful nerve-stimulant,  in  large  doses,  and  a  gentle  one,  a 
true  tonic,  in  small.  The  hydrochlorate  of  quinine, 
much  used  in  Europe,  is  far  superior  to  the  sulphate, 
which  is  almost  universally  used  in  America  for  three 
reasons;  it  has  greater  alkaloidal  strength,  is  more  solu- 
ble in  water  (one  in  thirty-four),  and  the  hydrochloric 
acid,  of  which  it  is  made,  corresponds  to  the  hydrochloric 
acid  of  the  gastric  juice. 

PHOSPHORUS  exists  in  the  body  of  an  adult  to  the 
amount  of  about  ix66  pounds;  this  occurs  chiefly  as  phos- 
phate of  lime,  phosphate  of  soda,  and  is  found  in  the 
brain  and  nerves  in  peculiar  compounds,  the  secret  of 
which  even  the  wonderful  chemistry  of  to-day  is  not  able 
to  entirely  discover. 

The  diet  in  daily  use  by  even  poor  American  men  and 
women  contains  more  than  enough  phosphorus,  in  a 
natural  form,  to  maintain  the  needs  of  the  body.  If,  dur- 
ing excessive  nerve-waste  from  overwork,  or  any  cause, 
the  supply  of  phosphorus  is  artificially  increased,  it  acts 
for  a  short  time  as  a  stimulant.  Under  the  stimulus  of  a 
strong,  rich  food  supply  the  tired  nerve-cells  are  enabled 
to  do  their  work  more  easily  ;  the  individual  feels  better. 
But,  very  soon,  the  capacity  of  the  nerve-cells  to  assimi- 
late an  unnatural  quantity  of  nutriment  becomes  ex- 
hausted ;  they  get  dyspeptic,  as  it  were,  and,  as  the 
unnatural  phosphorus  supply  is  brought  to  them  by  the 
blood-current,  they  refuse  it,  are  unable  to  use  it,  and  it 
is  borne  away  again  to  be  excreted  from  the  system. 
Thus,  in  the  end,  much  of  the  expensive  bottle  of  hypo- 
phosphites  finds  its  way  to  the  water-closet.  If  the  course 
of  phosphorus  be  wisely  managed,  if  the  patient's  nerve- 
waste  be  cut  down,  and  natural  remedies  be  brought  to 
cooperate  with  the  medicine,  it  may  produce  permanent 
benefit.  But  if  the  patient  has  continued  his  nerve- 
expenditure,  or  perhaps  increased  it  under  the  stimulat- 


126  NERVE   WASTE. 

ing  influence  of  the  drug,  the  result  is  that  when  the 
nerve-cells  have  cloyed  upon  their  high-pressure  diet  of 
phosphorus,  they  are  less  able  than  before  to  manage  the 
natural  phosphorus  supply  of  food.  These  remarks 
apply  particularly  to  phosphorus  pills  and  the  hypophos- 
phites.  It  is  my  opinion  that  the  reader  may  use  the 
phosphate  of  lime  and  phosphoric  acid  ad  libitum,  for  the 
reason  that  they  do  not  reach  the  nervous  system  at  all, 
the  former  becoming  insoluble  in  the  digestive  juices, 
and  the  latter  forming  phosphates  that  are  likewise  not 
absorbed.  Phosphoric  acid,  however,  has  some  value  in 
other  directions. 

The  late  Dr.  G.  M.  Beard  of  New  York,  who  probably 
treated  more  cases  of  nervous  exhaustion  than  any  other 
man,  wrote  : 

"Of  phosphates  this  can  be  said,  that,  like  iron  and  quinine, 
they  belong  to  the  list  of  over-praised  and  over-used  remedies,  at 

least  in  their  relations  to  neurasthenia These 

phosphates  and  phosphoruses  and  phosphites  are  good  remedies 
in  nervous  troubles,  but  if  they  had  anything  like  the  specific 
power  claimed  for  them,  there  would  be  little  need  for  treating 
these  cases ;  most  of  the  patients  that  I  see  have  taken  them  in 
abundance.  All  these  stock  remedies  have  a  certain  power  which, 
in  very  many  cases,  they  soon  expend.  They  reach  the  limit  of 
effect,  beyond  whicli  they  cannot  be  forced." 

Dr.  Samuel  Wilks,  whose  opinions  are  received  with 
respect  by  the  medical  profession  on  both  sides  of  the 
Atlantic,  in  a  recent  address,  says  : 

"  I  never  remember  seeing  more  than  one  patient  the  better 
after  taking  phosphorus,  and  therefore  I  am  bound  to  look  upon 
this  as  a  coincidence.  In  my  private  pharmacopoeia  I  have  at- 
tached to  the  word  phosphorus,  the  name  '  humbug.'  " 

My  own  faith  in  phosphorus  is  greater  than  that  of  Dr. 
Wilks,  but  I  quote  him  for  the  benefit  of  such  of  my 
readers  as  may  care  to  compare  the  conclusions  of  an  ex- 
perienced and  scientific  physician  with  the  statements 
of  some  of  the  many  shrewd  advertisements,  with  which 


NERVINES   AND    NERVE    TONICS.  I2y 

the  journals  of  the  day  abound.  The  ignorant  use  of 
phosphorus  may  occasionally  have  serious  results,  and  a 
case  was  recently  reported  in  which  a  woman  had  taken 
a  phosphorus  pill  three  times  a  day  for  two  years,  to 
strengthen  her  brain,  with  the  result  of  causing  a  chronic 
inflammation  and  partial  destruction  of  one  of  the  bones 
of  the  face. 

One  of  the  worst  cases  of  nervous  break- down  that  I 
have  ever  seen  was  in  a  young  married  man,  aged  thirty  - 
three,  a  victim  of  overwork  and  other  excesses.  He  in- 
formed me  that  he  had  been  taking  a  preparation  of  the 
' '  hypophosphites  of  lime,  potash,  manganese,  iron,  qui- 
nine and  strychnine,"  which  I  found  by  his  bedside, 
daily  for  over  a  year.  It  had  been  recommended  to  him 
by  a  neighboring  druggist,  "and  my  patient  informed  me 
that  it  had  done  him  a  great  deal  of  good.  This  young 
man,  with  his  emaciated  figure,  sallow  cheek  and  lustre- 
less eye,  was  a  picture  of  premature  old  age.  One  great 
injury  which  patent  medicines  do  by  their  fine  promises 
is  in  encouraging  the  nervous  to  rely  on  them  to  the 
neglect  of  other  and  wiser  measures. 

COCA  is  a  remedy  which  is  being  widely  advertised  as 
a  powerful  nerve  tonic.  It  is  really  a  sedative-stimulant, 
and  as  such  is  very  valuable  in  many  forms  of  nervous 
impairment.  The  active  principle  of  the  coca-leaf  is  the 
alkaloid  cocaine,  whose  power  of  paralyzing  sensation  in 
mucous  membrane  nerve-ends  makes  it  one  of  the  bless- 
ings of  modern  surgery.  This  anaesthetic  power  of 
cocaine  extends,  to  some  extent,  to  nerve-tissue  every- 
where— brain,  spine  and  nerves.  In  addition,  coca  has 
stimulant  and  excitant  properties  similar  to  those  of> 
strong  coffee.  In  these  two  properties  of  coca  reside  its 
remarkable  action.  It  soothes  away  the  intolerable  feel- 
ings of  nervous  or  muscular  fatigue,  experienced  by  many 
after  a  hard  day's  work,  into  a  feeling  of  comfort,  or  even 
of  mild  exhilaration.  It  promotes  the  flow  of  ideas,  and 


128  NERVE    WASTE. 

gives  an  artificial  sangfroid,  which  is  a  great  satisfaction 
to  nervous  and  diffident  public  speakers  and  others,  and 
which,  if  not  repeated  too  frequently,  is  harmless.  It 
temporarily  strengthens  the  voice,  and  has  quite  a  repu- 
tation for  this  purpose  among  singers  and  actors.  It  is 
the  best  remedy  against  mental  depression.  It  is  often 
successful  against  the  sleeplessness  which  comes  from 
brain  and  nerve  tire.  In  certain  cases  it  is  the  best  heart 
tonic.  It  is  useful  in  slow  convalescence  from  any  debili- 
tating disease,  and  is  able  to  comfort  and  sustain  the  aged. 

But  we  must  not  make  the  mistake  of  abusing  this 
medicine.  Used  regularly  in  full  doses  it  is  not  a  tonic 
in  the  sense  that  it  builds  up  the  brain-and-spine.  It 
modifies  sensation  and  increases  power,  not  by  adding 
anything  to  the  sum  of  vital  force,  but  by  calling  forth 
existing  resources;  in  other  words,  it  is  a  pure  stimulant. 
Coca,  like  many  other  stimulants,  maybe,  and  often  is  so 
gently  and  judiciously  used  as  to  permanently  improve  the 
nutrition  of  the  brain-and-spine,  and  thus  act  as  a  true  tonic. 

THE  ARITHMETIC  OF  TONICS. — In  a  large  proportion 
of  cases  tonic  medicines  accomplish  but  little  good.  If 
we  suppose  a  bottle  of  hypophosphites,  holding  96  tea- 
spoonfuls  to  represent  ninety-six  units  for  vitality,  over- 
work, worry,  sleepless  nights  or  any  continous  brain-and- 
spine  strain  will  counteract  this  twenty  fold  and  leave  a 
large  vital  loss  at  the  end  of  a  month.  Taking  a  tonic 
under  certain  circumstances  is  like  paddling  up  Niagara 
river  with  a  lath  or  fighting  a  conflagration  with  a 
syringe.  But  if  brain-and-spine  depressors,  devitalizers 
and  impoverishes  are  eliminated  from  the  case  the  month- 
ly balance  will  be  all  on  the  side  of  gain.  Ninety  phos- 
phorus pills,  reinforced  by  90  hours  of  oxygen  inhala- 
tion (out  of  doors),  90  hours  of  extra  sleep,  90  hours  of 
recreation,  90  good  appetites  and  720  hours  of  brain-and- 
spine  peace,  will  almost  realize  the  promises  of  the  nerve- 
food  man. 

\ 


XXIII 

DRUG   VICE    AND    MEDICINE    HABIT 

THE  BRAIN  AND  NERVE  POISONS. — Since  morphine, 
chloral  and  the  bromides  became  well  known  to  the  peo- 
ple, three  new  nervous  diseases  have  been  added  to  the 
list,  books  are  written  on  the  treatment  of  morphino 
mania,  chloral  and  bromide  addiction,  and  asylums  are 
built  to  accommodate  the  increasing  number  of  victims. 

The  new  nervines,  cocaine,  antipyrine,  acetanilide,  and 
others  still  newer,  are  becoming  popularized  with  alarm- 
ing rapidity. 

Dr.  Warren-Bey  writes  to  the  Virginia  Msdical  Monthly,  that 
the  extent  to  which  antipyrine  is  employed  in  Paris  is  incredible. 
The  average  French  doctor  prescribes  it  for  all  the  ills  that  flesh  is 
heir  to ;  it  has  become  as  necessary  an  article  in  every  lady's  bou- 
doir as  her  perfume-bottle ;  scarcely  a  man  can  be  found  who  has 
not  some  of  it  carefully  stored  away  in  his  pocket-book ;  children 
are  raised  on  it,  and  cry  for  it  as  for  their  biberons ;  and,  in  fact, 
they  all  take  it,  and  for  all  things,  but  especially  for  migraine, 
which,  as  you  know,  is  pre-eminently  the  malady  of  those  who  in- 
dulge in  social  dissipation.  "  That  you  may  form  an  idea  of  the 
extent  to  which  it  is  the  rage,  I  will  give  you  an  incident  as  it  was 

told  me  by  the  party  immediately  concerned  :  Mrs.  P. was 

dining  out  recently  in  the  Faubourg  St.  Germain,  when  she 
chanced  to  mention  that  she  had  suffered  with  headache  during 
the  day.  Instantly,  from  the  pockets  of  thirteen  of  the  fifteen 
guests  who  were  present,  antipyrine  was  produced — in  capsules, 
wafers,  powders,  and  elixirs — and  she  was  compelled  to  take  a 
dose  then  and  there,  noth withstanding  her  earnest  protest,  and 
her  assurance  of  entire  relief  before  starting  from  home." — N.  Y. 
Medical  Record. 

Although  the  recent  nervines  are  not  yet  seen  to  be 
very  injurious  (as  chloral  was  not  at  first),  yet  our  expe- 
rience justifies  us  in  formulating  a  law  that  the  habitual 

9  (129) 


I3O  NERVE    WASTE. 

use  of  any  drug  which  quickly  and  powerfully  influences 
the  nervous  tissues  is  injurious  to  their  nutrition. 

If  we  seek  the  causes  which  have  led  to  the  wide-spread 
and  spreading  drug-intemperance,  we  note  first  of  all  the 
example  of  the  physician.  The  great  use  of  stimulants 
and  sedatives  by  medical  men  suggests  the  idea  that  there 
is  virtue  in  them,  and  in  action  the  drugs  speak  for  them- 
selves. The  patient  does  not  always  realize  that  that 
which  is  simply  a  tonic  or  a  stimulant  of*  a  sedative  in 
skillful  hands  may  easily  become  a  poison  in  unskillful 
ones,  and  thus  he  is  often  betrayed  into  tampering  with 
dangerous  agents.  We  do  not  give  our  patients  the  best 
service  of  which  we  are  capable  when  we  resort  too  readily 
to  palliative  drugs.  Probably  we  should  more  often 
teach  that  pain,  sleeplessness,  headache  are  beneficent 
warnings,  reminders  that  something  needs  adjusting, 
rather  than  evil  spirits  to  be  cast  out  by  chemicals.  But 
weak  as  we  are,  and  desirous  to  please,  we  find  the  magi- 
cally acting  drug  a  greater  triumph,  at  the  time,  than  any 
ascetic  doctrine  of  vital  economy.  When  these  drugs 
must  be  given,  it  would  be  better  if  patients  remained  in 
ignorance  of  what  they  are  taking;  such  ignorance  could 
do  no  harm,  and  here  very  often,  "  a  little  knowledge  is  a 
dangerous  thing." 

The  enterprise  of  certain  manufacturing  pharmacists  has 
of  late  become  active  in  cultivating  the  use  of  powerful 
drugs  among  the  people.  Seizing  upon  the  labors  of  the 
physiologist  and  the  clinician  these  gentlemen  devise  com- 
binations of  the  most  potent  drugs  and  exhaust  their 
fertile  imaginations  in  advertising  them — ostensibly  to  the 
medical  profession,  but  practically  to  the  people. 

To  our  shame,  there  is  no  lack  of  physicians  who,  in 
ignorance,  or  for  the  paltry  gratification  of  seeing  their 
names  on  a  proprietary  medicine  wrapper,  laud  these 
preparations  to  the  skies.  Some  of  what  should  be  the 
most  honored  names  in  American  medicine  are  flaunted, 


DRUG   VICE   AND   MEDICINE    HABIT.  13! 

million  fold,  in  the  face  of  the  public,  and  given  the  ap- 
pearance of  recommending  this  man's  " powerful  tonic," 
or  that  one's  remedy  for  headache.1  With  unique  impu- 
dence many  manufacturing  pharmacists  have  undertaken 
the  education  of  the  medical  profession,  and  from  among 
their  boxes  and  barrels  issue  books  and  circulars  on  the 
art  of  curing  disease  which  have  no  little  influence  upon 
those  of  our  90,  ooo  physicians  who  are  ignorant,  or  feeble- 
minded, or  who  have  no  other  source  of  information. 
One  of  over  a  hundred  physicians'  testimonials  to  the 
virtues  of  a  certain  widely  advertised  sedative  is  so  illus- 
trative, so  suggestive  and  withal  so  naive,  that  I  quote 
it;  the  italics  are  mine. 

Dr. , ,  writes:  " gives  more  relief  in  cases  of 

headache  than  any  remedy  I  have  used  before.  In  two  cases  of 
nervous  prostration  where  other  remedies  failed  to  give  relief, 
both  ladies  being  married,  and  great  sufferers  from  almost  contin- 
uous headaches,  your gave  permanent  relief  without  any  bad 

effects.  In  some  cases,  I  find  the  remedy  has  to  be  persisted  in 
before  permanent  cure  is  effected.  To  my  certain  knowledge^  I 
have  now  six  families  on  my  list  who  ate  never  without  a  bottle  of 

in  the  house.    It  is  a  welcome  medicine  to  my  suffering 

patients." 

We  may  safely  suppose  that  the  *  *  permanent  cure ' '  will 
continue  until  the  "bottle  in  the  house"  has  lost  its 
power,  and  that  the  gentleman  can  give  his  two  patients 
(both  married)  better  care  than  dosing  them  with  bro- 
mides is. 


1  Many  proprietary  preparations,  it  is  fair  to  say,  are  more  elegant,  convenient 
and  portable  than  any  prescription  of  the  same  ingredients  could  be  made; 
specialism  in  pharmacy,  as  in  medicine,  excels  in  some  respects.  But  "  good 
wine  needs  no  bush"  is  not  an  axiom  with  the  manufacturing  pharmacist,  and 
the  specious,  ignorant  or  false  statements  which  some  manufacturers  see  fit  to 
supply  with  their  bottles  make  them  infinitely  mischievous.  Having  some  ac- 
quaintance with  the  proprietary  preparations  on  the  American  market  (which 
differ  from  patent  medicines  in  being1  non-secret,  often  meritorious,  and  in 
being — ostensibly  at  least — addressed  to  the  medical  profession)  I  can  at  this 
moment  scarcely  recall  two  whose  advertisements  state  the  truth,  the  whole 
truth,  and  nothing  but  the  truth,  and  do  not,  designedly  or  otherwise,  suggest 
a  false  idea  of  their  real  power  and  uses. 


132  NERVE    WASTE. 

ABUSE  OF  TONICS. — Sufferers  from  any  chronic  disease 
are  apt  to  become  addicted  to  self-drugging.  There  seems 
to  be  a  tendency  in  human  nature  to  search  for  some  mys- 
terious substance  to  charm  away  disease,  or  to  renew  the 
vigor  of  youth;  the  history  of  Ponce  de  L,eon  is  daily  re- 
peated in  every  drug  store  in  the  land.  We  prefer  to  find 
health  rather  than  try  for  it,  just  as  we  prefer  winning  a 
fortune  to  saving  it.  Marvellous  cures,  faith-cures  and 
every  novelty  in  cures  that  promises  restoration  of  health 
without  penalty  for  hygienic  sins,  and  without  the  price  of 
effort,  are  welcomed  by  the  people  ;  false  teachers  in  the 
gospel  of  health  flourish.  Remedies  about  which  there  is 
no  mystery — sunshine,  pure  air,  proper  food  and  correct 
habits  are  not  very  popular;  though  their  value  is  felt 
and  admitted;  they  are  too  homely  and  slow.  In  spite 
of  repeated  disappointments  the  sick  turn  again  and  again 
to  the  druggist.  The  druggist,  in  his  turn,  does  not  use 
much  medicine;  for  him  the  element  of  mystery  is  lacking. 

PATENT  MEDICINES. — Since  the  time  that  men  first  saw  in 
the  misery,  the  ignorance,  the  vain  wishes  and  the  credu- 
lity of  the  sick  a  fine  field  for  commercial  enterprise,  and 
assumed  the  responsibility  of  advising  and  treating  them 
by  wholesale,  self-drugging  has  increased  until  it  has  now 
reached  the  proportions  of  a  national  evil.  More  than 
twenty- two  million  dollars  are  annually  expended  in  the 
United  States  for  patent  medicines  alone,  and  between 
five  and  eight  million  dollars  are  paid  for  advertising 
them.  Before  the  abolishment  of  the  stamp-tax  a  few 
years  ago,  patent  medicines  brought  the  government  an 
annual  income  of  one  million  eight  hundred  thousand 
dollars.  The  advertisements  of  patent  medicines  are  nearly 
as  great  an  evil  as  the  medicines  themselves  are,  since 
their  artful  descriptions  and  sensational  appeals  influence 
hundreds  of  thousands  of  well  persons  into  believing 
themselves  sick. 


DRUG   VICE   AND    MEDICINE    HABIT.  133 

The  universal  habit  of  medicine  swallowing  immensely 
increases  the  aggregate  of  medical  pratice,  and  it  is  not 
exactly  worldly-wise  in  a  physician  to  rail  against  these 
aids  to  his  business.  But  here  I  may  be  pardoned  an 
observation  :  there  is  a  wide  difference  between  the  true 
physician  and  those  merchants  who  reach  after  and  treat 
the  sick  upon  strictly  business  principles.  The  medical 
profession  has  its  faults,  but  one  of  its  glories  is  that  the 
traditions  of  centuries,  and  a  powerful  professional  opinion 
lead  even  a  selfish  man  to  place  the  welfare  of  his  patient 
above  his  own  pecuniary  interests.  What  a  contrast 
between  this  attitude  and  that  of  those  pretenders  who 
"  sell  what  never  can  be  bought,"  or  of  those  renegades 
who  realize  the  words  of  the  great  Abernethy ,  ' '  Medicine 
is  the  noblest  of  professions,  but  the  meanest  of  trades. " 

Professional  egotism  is  a  fault  from  which  medical 
men  are  not  exempt,  but  it  is  not  so  unfounded  nor  so 
dangerous  as  lay  egotism.  There  is  no  other  scientific 
subject  in  which  the  people  feel  so  much  ableness  as  in 
therapeutics.  Men  and  women  who  would  not  meddle 
with  a  watch  or  a  piano  do  not  hesitate  at  the  human 
body.  Not  a  few  persons  even  distrust  physicians,  seem- 
ing to  think  that  a  medical  education  warps  or  stunts,  or 
in  some  way  unfits  a  man  to  care  for  disease.  I  remem- 
ber being  called  many  years  ago  to  the  bedside  of  a 
young  woman,  who  had  been  treated  without  much  suc- 
cess for  three  days  by  her  mother.  The  good  lady 
wished  no  more  from  me  than  the  name  of  the  malady  ; 
"we  have  Dr.  Gunn's  Family  Physician  in  the  house," 
said  she,  "and  we  always  treat  by  that."  I  had  lately 
to  envy  the  complacent  completeness  of  a  system  of  medi- 
cine, propounded  by  a  man  who  is  wise  enough  in  his 
own  trade.  Said  he,  "  all  diseases  come  from  the  blood  ; 
all  you  have  to  do  to  keep  well  is  to  thicken  it  up  in  the 
fall  with  a  little  sarsaparilla,  and  thin  it  down  in  the 
spring  with  a  little  blue  mass."  The  lay  egotist  observes 


134  NERVE    WASTE. 

one  case,  and  makes  rules  for  all  the  world ;  the  scientific 
physician  observes  twenty  cases  and  is  silent. 

The  most  pathetic  (and  of  late  too  frequently  reported) 
instances  of  lay  egotism  are  those  in  which  a  deluded 
mother,  convinced  of  her  supernatural  healing  power, 
permits  a  helpless  child  to  die  without  earnest  skillful 
effort  to  save  it. 

AMATEUR  PHYSICIANS. — The  popularizing  of  knowledge, 
which  is  one  characteristic  of  the  mental  activity  of  our 
time,  has  drawn  the  veil  from  all  the  sciences,  and  from 
none  more  completely  than  the  medical  sciences.  The 
reading  public  feels  some  familiarity  with  medical  theo- 
ries, and  is  more  or  less  informed  in  new  remedies.  This 
is  desirable,  for  intelligent  men  make  the  best  patients. 
But  a  certain  proportion  of  intelligent,  imaginative  and 
self-confident  persons  make  the  mistake  of  practising 
medicine  upon  this  imperfect  "knowledge.  The  amateur 
doctor  is  everywhere  about,  and  manages  his  own  ills 
and  advises  in  those  of  his  friends  with  a  confidence 
which  the  oldest  physician  might  envy.  Such  a  man  is 
above  patent  medicines ;  he  reads  standard  medical 
treatises,  and  uses  the  tools  of  the  educated  physician. 
Many  invalids  enter  upon  this  amusement  as  they  would 
upon  amateur  photography,  or  bicycling,  and  I  have 
known  a  gentleman  to  spend  large  sums  of  money  on 
books  and  apparatus,  and  treat  himself  for  months,  be- 
fore discovering  that  he  was  treating  the  wrong  disease. 
New  drugs  as  fast  as  they  appear  are  known  to  the  ama- 
teur doctor,  and  used  by  him  perhaps  more  extensively 
than  by  physicians.  Coca,  cocaine,  antipyrin,  antifebrin, 
caffeine,  and  other  drugs  are  to-day  largely  in  the  hands 
of  the  laity. 

There  are  three  good  reasons  why  amateur  drugging 
is  not  wise,  and  why  it  seldom  permanently  benefits  : 

i .  It  is  based  upon  unskillful  diagnosis.  The  art  of 
knowing  how,  and  how  far  any  man  varies  from  the  nor- 


DRUG   VICE    AND    MEDICINE    HABIT.  135 

mal  standard  is  the  finest  in  medicine,  and  is  essential  to 
wise  treatment.  A  sick  man's  mind  is  not  to  be  trusted  to 
decide  upon  the  nature  and  degree  of  his  disease.  It  is 
apt  to  be  biased  by  its  own  fears  and  wishes.  Physicians 
know  this,  and  when  sick,  rely  upon  some  professional 
brother. 

2.  It  lacks  wisdom  in  selecting  remedies.     Wisdom  is 
something  more  than  intelligence  ;  it  is  intelligence  plus 
experience.     The  girl  of  fourteen  and  the  matron  of  forty 
may  read  the  same  novel,  but  how  different  are  the  pic- 
tures which  its  pages  suggest  to  each.     Physicians  have 
constant  examples  of  the  fact  that  the  judgment  of  the 
most  intelligent  man  is  worth  little  outside  the  range  of 
his  own  immediate  experience. 

Intelligence  without  experience  is  misled  by  taking 
theories.  Immense  sums  are  spent  annually  in  this 
country  to  persuade  that  certain  drugs  have  a  specific 
power  over  nervous  weakness.  The  plausible  logic  of 
the  nerve-food  and  nerve- tonic  man  commends  itself, 
not  only  to  the  ignorant,  but  to  the  most  intelligent. 
But,  in  medicine,  good  logic  is  not  always  good  prac- 
tice. The  literature  of  medicine  is  full  of  good  theories 
that  cannot  be  made  to  work  in  the  sick  room.  There 
are  good  chemical  theories  for  the  cure  of  diphtheria, 
consumption,  diabetes;  but  the  working  physician  is  not 
able  to  realize  their  promises.  The  chemist  can  formu- 
late a  perfect  theory  for  making  thin  people  fat,  and  fat 
people  thin,  but  it  has  a  very  limited  use  in  real  life. 

3.  It  lacks  judgment,  proportion,  discretion,  in  apply- 
ing  medicines.     Degree   is   everything   in   therapeutics. 
Every  drug,  indeed  every  force,  which  has  real  power 
against  disease,  has  a  certain  action  and  produces  a  cer- 
tain reaction   in  the  tissues  ;  the  management  of  these 
actions  and  reactions  is  an  important  part  of  the  physi- 
cian's skill.     It  is  very  easy  for  stimulation  to  become 
Over-stimulation  (irritation  and  exhaustion)  and  for  seda- 


136  NERVE    WASTE. 

tion  to  become  depression.  A  few  facts  may  serve  to 
indicate  that  drug-giving  is  a  more  intricate  science  than 
many  suppose. 

1.  The  effect  of  most  medicines  varies  greatly  with  the 
dose  in  which  they  are  given;  quinine  in  small  doses  is  a 
very  good  remedy  in  certain  headaches;  in  large  doses  it 
often   causes   terrible   headache;    opium   in   small   doses 
strengthens  the  heart ;  in  large  doses  it  weakens  it  to 
death;  ipecac  is  one  of  the  surest  emetics;  it  is  also  one 
of  the  best  medicines  to  arrest  vomiting;  arsenic,  in  large 
doses,   poisons  to  death  by  its  irritant  effect  upon  the 
stomach;  in  small  doses  it  is  successfully  used  to  soothe 
the  stomach  and  to  allay  vomiting;  calomel  is  a  powerful 
purgative — it  is  used  extensively,  in  small  doses,  to  soothe 
the  irritated  stomach  lining. 

2.  The  length  of  time  any  drug  is  continued  affects  the 
result.     All  the  ' '  bitters  ' '  and  stomachic  tonics,  which  at 
first  increase  the  digestive  power  if  used  too  long,  cause 
dyspepsia.     Over-stimulation  ends  in  exhaustion.     The 
same  principle  applies  to  purgative  pills.     Here  is  one  of 
the  ways  in  which  unwise  drugging  does  harm.     Many 
persons  reason  that  if  one  bottle  is  good,  twelve  bottles 
are  twelve  times  as  good;  they  pass  in  the  dark  the  point 
where  the  medicine  ceases  to  be  of  any  use,  or  becomes  an 
injury  in  their  particular  case.     This   over- doing   is   a 
characteristic  of  domestic  treatment.     It  is  not  uncommon 
to  meet  persons  who  have  been  having  some  prescription 
refilled  for  years,  not  knowing  that  the  fact  that  it  did 
them  much  good  at  one  time,  does  not  prevent  it  doing 
them  much  harm  later.     The  "tonic"  habit,  the  "bit- 
ters," and  the  purgative  pill  habits,  are  as  injurious  in 
their  way  as  the  morphine,  chloral  and  alcohol  habits. 
For  many  years  the  liver  was  a  favorite  talisman  with 
those  persons  who  live  by  playing  upon  the  fears  of  the 
sick,  but  lately  the  kidneys  have  become  a  favorite  organ, 
as  affording  even  a  greater  scope  for  business  enterprise. 


DRUG  .VICE    AND    MEDICINE    HABIT.  137 

Most  of  the  ' '  kidney-cures  "  advertised  so  freely,  are  to 
the  kidneys  what  a  drastic  purgative  is  to  the  bowels — 
they  "scour  them  out."  Some  kidneys  need  a  drastic 
influence,  and  the  individual  feels  better  after  using  these 
compounds;  but  their  continued  use,  or  their  use  in  per- 
sons whose  kidneys  happen  to  be  irritable,  sensitive, 
congested  from  exposure  to  cold,  or  some  other  cause,  or 
in  persons  who  have  inherited  a  tendency  to  inflammation 
of  the  kidney  may  easily  result  in  incurable  Bright' s  dis- 
ease. 

j.  The  combination  of  drugs,  so  that  certain  powerful 
ones  are  modified,  corrected,  assisted,  is  a  principle  of 
drug-using  that  has  made  great  progress  in  modern  medi- 
cine; this  principle  is  especially  valuable  with  ' '  neurotics, ' ' 
that  class  of  medicines  used  to  affect  the  nervous  system. 

/.  Age,  temperament,  inherited  tendencies,  climate,  occu- 
pation and  many  other  circumstances  influence  the  choice 
and  the  dosage  of  drugs;  twin  brothers  having  the  same 
disease  might  require  altogether  different  medicines  and 
directions. 

It  would  be  a  great  blessing  if  a  safe  and  sure  method 
of  home  treatment  for  every  disease  could  be  perfected 
and  taught;  tens  of  thousands  of  the  sick  poor  are  unable 
to  secure  adequate  medical  aid,  and  only  a  small  portion 
of  the  sick  are  treated  by  physicians. 

But  skill  comes  only  by  practice.  A  novice  in  rifle- 
firing  sees  the  target  and  has  intelligence  to  estimate  the 
distance  and  point  the  gun,  but  he  cannot  hit  the  mark. 
The  inexperienced  young  housewife  may  study  the  recipe 
and  measure  the  ingredients  ever  so  carefully,  but  the 
bread  is  a  failure.  Dr.  Holmes,  speaking  of  physicians, 
says,  "  The  young  man  knows  the  rules,  but  the  old  man 
knows  the  exceptions;"  and  before  reaching  the  wisdom 
to  effectually  use  drugs,  the  brightest  intelligence  must 
be  qualified  by  years  of  observation  in  the  sick  room. 
Most  of  the  advertised  remedies  against  nervous  impair- 


138  NERVE    WASTE. 

inent  are  manufactured  to  sell,  and  have  no  relation  to 
scientific  treatment.  But  if  a  physician  were  to  lay  before 
his  patient  a  carefully  selected  stock  of  instruments  and 
medicine,  in  many  cases  he  would  injure  rather  than 
benefit  himself  with  them.  A  set  of  watchmakers'  tools 
may  be  used  to  ruin  a  watch  as  effectively  as  a  crowbar. 

There  is  no  work  in  which  trained  perceptions,  the 
habit  of  study,  solid  thought  go  for  more  than  in 
the  work  of  curing  disease.  So  let  not  my  reader  ever 
imagine  that  the  prescription  of  some  famous  physician, 
written  for  another,  will  necessarily  be  of  use  in  his  case, 
for  the  most  important  thing  about  a  prescription  for  the 
patient,  is  the  wisdom  which  directs  its  use.  The  knowl- 
edge that  decides  what  remedy  to  use,  how  long  to  use  it, 
when  to  modify  or  combine  it  with  other  remedies,  when 
to  stop  its  use  for  a  time,  and  when  not  to  use  it  at  all 
can  never  be  conveyed  within  the  limits  of  a  patent 
medicine  circular. 

Many  cases  of  nervous  debility  are  best  cured  without 
the  use  of  any  medicines  whatever;  all  they  need  is  good 
advice,  and  the  wisdom  to  follow  it,  to  get  well.  There 
is  a  class  of  patients  which  comes  to  the  physician  with  a 
history  of  prolonged  and  copious  ' '  medicine-bibbing  and 
drug- tippling  "  as  it  has  been  termed.  They  have  ' '  tried 
everything  "  and  doctored  for  every  chronic  disease,  with 
physicians  of  every  school,  including  magnetic  healers 
and  the  faith-cure,  and  the  physician  feels  that  he  is  in 
the  presence  of  a  very  experienced  patient  indeed.  It  is 
not  always  that  this  class  of  patients  can  be  sufficiently 
controlled  to  get  well;  but  when  they  can  be,  it  is  remark- 
able what  results  can  be  produced  by  a  course  of  treat- 
ment which  may  not  include  a  single  teaspoonful  of  med- 
icine. 

The  story  of  one  case  may  be  instructive.  The  patient 
was  a  very  intelligent  young  man,  a  college  student. 
Some  six  months  before  coming  to  me  he  began  to  treat 


DRUG   VICE   AND    MEDICINE    HABIT.  139 

himself  for  nervous  debility.  He  avoided  all  advertised 
nostrums,  and  procured  standard  medical  treatises,  which 
he  studied  carefully,  yet  the  conclusions  which  he  drew 
from  these  did  him  considerable  injury.  During  most 
of  this  time  he  was  taking  phosphorus  pills  with  other 
drugs,  such  as  strychnine  and  quinine,  which  he  had 
learned  were  powerful  nerve- tonics.  He  subjected  him- 
self to  a  daily  cold  shower  bath  as  prolonged  as  he  could 
bear;  he  exercised  beyond  his  strength;  he  purchased  an 
electric  battery  and  used  it  for  several  months;  but,  con- 
cluding that  it  did  him  no  good,  he  gave  up  its  use.  He 
thought  and  worried  constantly  about  his  condition. 
When  he  first  came  under  my  notice  he  was  quite  thin, 
visibly  nervous,  unable  to  study,  his  appetite  capricious, 
and  altogether  he  was  considerably  worse  than  when  he 
began  to  treat  himself.  Upon  taking  charge  of  his  case  I 
abolished  all  medicines  ;  his  cold  bathing  I  changed  to  a 
hot  salt  water  bath  every  other  day,  and  devoted  myself 
to  curing  certain  local  conditions  of  the  reproductive  sys- 
tem which  were  at  the  bottom  of  his  trouble.  When 
this  was  nearly  accomplished  his  vacation  came  on,  and  I 
sent  him  to  the  country  ;  he  spent  six  weeks  in  the  Santa 
Cruz  mountains,  and  returned  thoroughly  well,  having 
gained  sixteen  pounds  in  weight,  and  he  has  remained 
so  since.  One  of  the  most  important  factors  in  the  cure 
of  this  patient  was  the  mental  load  which  he  got  rid  of  in 
thoroughly  understanding  his  condition  and  prospects, 
and  in  shifting  the  responsibilities  of  his  treatment  from 
his  own  shoulders  to  those  of  a  physician. 


XXIV 

ELECTRICITY    AS    A    REMEDY 

Electricity  is  one  of  the  modes  of  molecular  motion  like 
heat,  light,  and  sound,  and  is  convertible  into  these  forces. 

Three  kinds  of  electricity  are  used  in  medicine:  i,  the 
Galvanic,  or  constant  current,  obtained  from  chemical 
action  in  a  number  of  cells,  from  one  to  sixty;  2,  the 
Faradic,  or  interrupted  current;  this  is  an  induced  or 
secondary  current,  obtained  by  the  magnetizing  and  de- 
magnetizing of  a  rod  of  soft  iron,  around — but  not  through 
— which  a  galvanic  current  from  one  to  four  cells  is  made 
to  pass;  3,  Static  or  Frictional  electricity,  developed  by 
friction  between  large  revolving  plate-glass  wheels  and 
rubbers;  in  using  this  kind  of  electricity  the  patient  is 
insulated  and  charged,  like  a  Ley  den  jar,  and  then,  by 
touching  his  body  in  various  places  with  metal  rods,  the 
electric  force  is  drawn  out  at  any  desired  point.  With  a 
good  machine  it  is  possible  to  draw  sparks  from  one  to 
twelve,  or  even  more,  inches  long  from  certain  parts  of 
the  body. 

The  two  first  mentioned  forms  of  electricity  are  of  the 
most  value  in  nervous  impairment.  The  galvanic  current 
gives  merely  a  superficial  sensation;  it  is  a  silent  current  of 
great  quantity  but  of  low  intensity.  The  Faradic  current, 
on  the  other  hand,  is  readily  felt  within  because  of  its  high 
degree  of  intensity.  The  constant  current  has  been  com- 
pared to  a  mighty,  slowly  moving  river  ;  the  interrupted 
current  to  a  rapid,  leaping,  noisy  mountain  brook.  The 
current  of  frictional  electricity  has  a  high  tension,  but 
this  form  of  electricity  collects  chiefly  upon  the  surface  of 
the  body,  and  never  penetrates  very  deeply  below  the 
skin. 

(140) 


ELECTRICITY    AS    A    REMEDY.  141 

When  the  electric  current  is  passed  through  the  body 
several  effects  are  produced,  according  to  the  kind  of  cur- 
rent used  ;  the  particular  nerves  it  is  made  to  traverse, 
the  quantity  or  the  intensity  of  it ;  the  direction  it  is  made 
to  take,  whether  toward  or  away  from  the  central  nervous 
system  ;  the  length  of  time  it  is  used  at  each  sitting  ;  the 
peculiar  susceptibility  of  the  patient,  and  the  dosage  of  it. 

It  is  only  within  a  few  years  that  physicians  have  prac- 
tised the  measurement  of  the  electric  current,  but  this 
assistant  to  the  remedial  use  of  a  powerful  agent  is  .most 
important ;  the  battery  differs  on  different  days  ;  ten  cells 
on  Monday  may  represent  a  different  amount  of  electricity 
from  ten  cells  on  Tuesday  ;  again  the  patient's  suscepti- 
bility and  conductibility  may  differ  on  different  days.  In 
many  cases  in  which  electricity  is  used  it  is  highly  im- 
portant to  have  a  uniform,  or  slightly  increasing  dose  at 
each  sitting,  and  this  result  can  only  be  attained  by 
means  of  a  delicate  instrument  called  the  milliampere- 
metre.  A  recent  writer  remarks :  "I  can  as  easily 
imagine  a  drug  store  without  scales  as  a  medical  battery 
without  a  metre." 

The  electrical  procedures  used  in  nervous  impairment 
are  : 

1 .  ' '  Galvanization  of  the  Neck  "  or  ' '  of  the  Cervical 
Sympathetic."     In  this  operation  the  circuit  is  made  to 
pass  through  certain  nerve-centres  which  have  an  impor- 
tant influence  upon  the  circulation  and  upon  the  nutri- 
tion of  the  whole  body. 

2.  Central    Galvanization,    in    which    the    negative 
pole  is  placed  over  the  stomach  (and  thus  over  the  great 
solar  plexus  of  the  sympathetic)  and  the  positive  pole  at 
various  points  upon  the  spine  and  neck.     This  procedure 
powerfully   influences  the   circulation,  excretion  in  skin, 
and  nutrition  in  brain-and-spine. 

3.  Spinal   Galvanization,  in  which  the  entire  spine  is 
subjected  to  the  galvanic  current. 


142  NERVE    WASTE. 

4.  Abdominal   Galvanization,  includes  the  spine  and, 
in  turn,  the   various  digestive  organs  within  the  circuit. 
It  is  a  powerful  stimulus  or  tonic  (according  to  degree), 
increasing  liver-action,    bile-flow  and  in  some  cases  re- 
moving chronic  constipation. 

5.  Genito-Spinal    Galvanization    subjects    the  entire 
reproductive  apparatus,  including  the  lower  spine,  to  the 
galvanic  current.     In   sexual  neurasthenia  this  operation 
has  the  power  of  allaying  irritability  and  improving  nu- 
trition in  a  remarkable   degree,  and  in  functional  pelvic 
disorders   of  women   it   is   one  of  the   most   efficacious 
remedies. 

6.  General  Galvanization   subjects  the  entire    body, 
from  neck  to  feet,  to  the  action  of  the  galvanic  current. 

7.  General  Faradization  consists   in   subjecting    the 
whole  body,  from  neck  to  feet,  to  the  induced  current. 
It  is  useful,  but  less  so,  in  my  hands  than  central  or  gener- 
al galvanization. 

8.  The  Electrical  Bath,  much  thought  of  by  some,  has 
in  a  large  proportion  of  cases  no  advantages  over  less  trou- 
blesome methods.     It  diverts,   instead  of  concentrating 
the  current — a  disadvantage  where  local  organs  are  to  be 
influenced.     I^ocal  forms  of  electrical  bath   are,  in  some 
cases,  very  useful. 

The  various  remedial  uses  of  electricity  may  be  summed 
up  as  follows : 

1 .  It  is  a  powerful  stimulant  and  tonic,  not  because  it 
adds  anything  to  the  tissues  in  passing  through  them, 
but  because  it  rouses  them,  stirs  them  up,  revivifies  or 
puts  new  life  into  them,  and  thus  enables  them  to  assim- 
ilate and  make  new  tissue  and  force. 

2.  It  may  be  made  to  exert  a  sedative  or  soothing 
effect  upon  internal  organs  that  can  be  reached  in  no 
other  way  ;  this  it  does  by  a  gentle  stimulant  or  counter- 
irritant  action — just  as  we  rub  a  flea-bite  to  soothe  the 
irritated  skin  ;  and  in  congestions  of  deep-seated  parts  it 


ELECTRICITY   AS   A    REMEDY.  143 

acts  by  contracting  the  relaxed  and  flabby  tissues,   and 
emptying  them  of  surplus  blood. 

3.  It  can  produce  an  alterative  effect,  /.  e. ,  cause  a 
wholesome   change  in  organs,  the  seat  of  some  morbid 
process,  in  a  manner  which  we  cannot  explain. 

4.  It  can  be  made  to  counter-irritate  and  powerfully 
impress  superficial  nerve-ends,  and  thus,  through  them, 
the  central  nerve-cells. 

The  power  of  electricity  to  influence  nutrition  in  brain- 
and-spine  constitutes  its  greatest  usefulness  in  nervous 
debility.  In  the  treatment  of  all  the  functional  nervous 
disorders — epilepsy,  St.  Vitus'  dance,  hysteria,  writer's 
cramp,  neuralgia,  sick  headache — this  tonic  influence  of 
electricity  is  one  of  our  chief  resources.  In  the  various 
local  phases  of  nervous  impairment — in  the  irritable 
spine,  the  irritable  ovary,  the  irritations  and  weaknesses 
about  the  male  reproductive  organs,  the  most  gratifying 
results  are  often  obtained  with  this  remedy.  The  stimu- 
lant and  the  sedative  action  of  both  the  galvanic  and 
faradic  currents  is  sometimes  efficacious  against  the 
paroxysms  of  sick  headache  and  neuralgia. 

The  use  of  electricity  as  a  remedy  requires  a  thorough 
knowledge  of  the  anatomy  of  the  nervous  system,  of  the 
exact  location  of  the  nerve-centers  to  be  treated,  and  of 
the  geography  of  the  various  nerves.  It  is  perhaps  need- 
less to  say  that  the  passing  of  a  current  from  one  hand  to 
another,  through  the  arms,  has  no  value  in  the  treat- 
ment of  nervous  impairment ;  as  well  might  one  rub  an 
internal  medicine  upon  the  hands  and  expect  benefit.  To 
do  good  electricity  must  be  made  to  pass  through  the 
diseased  parts. 

The  electric  belts,  electric  corsets,  electric  brushes,  and 
other  cunning  baits  for  inexperience,  are  useless  in  ner- 
vous impairment,  though  the  purchaser  sometimes  gets 
his  money's  worth  in  experience  ;  these  toys  have  no 
effect  other  than  that  which  they  occasionally  produce 


144  NERVE   WASTE. 

upon  the  imaginations  of  certain  persons.  A  proposal  to 
use  electricity  is  not  unfrequently  met  with  some  such 
remark  as  this,  "  Oh  !  I  have  tried  that ;  it  is  of  no  use 
in  my  case,"  and  questioning  develops  the  fact  that  the 
patient  has  worn  an  electric  belt,  or  that  he  is  the  owner 
of  a  Faradic  battery.  The  calm  self-confidence  of  many 
persons  in  their  ability  to  use  tools  which  it  has  taken 
him  years  of  labor  to  learn  to  use  is  sometimes  a  little 
piquing  to  the  physician  ;  a  truer  way  to  put  it  would  be 
that  an  unskillful  use  of  a  good  remedy  has  failed,  as 
unskillful  attempts  in  any  direction  are  very  apt  to  do. 

Scientific  electricity  has  other  resources  beside  those 
used  in  the  cure  of  nervous  debility.  As  a  means  of 
diagnosis  it  is  very  valuable  to  the  neurologist ;  the  gal- 
vano-cautery  enables  the  surgeon  to  remove  many  dis- 
eased growths,  and  to  perform  many  operations  without 
the  loss  of  a  single  drop  of  blood.  Probably  the  most 
remarkable  action  of  electricity  in  the  human  body  is 
that  known  as  electrolysis,  by  which  abnormal  growths 
and  tissues  are  made  to  disappear  by  being  decomposed 
into  their  chemical  elements.  Two  highly  important 
applications  of  electrolysis  have  been  established  within 
the  past  few  years — the  removal  of  fibroid  tumors  of  the 
womb,  and  the  melting  away  of  strictures  of  the  male 
urethra,  and  in  each  of  these  cases  electrolysis  replaces 
dangerous  surgical  operations. 


XXV 

SURFACE     REMEDIES 

The  skin  is  not  popularly  thought  of  as  an  organ,  but, 
with  its  2,500  square  inches  of  surface,  its  7,000,000  folli- 
cles, its  1,750,000  inches  (28  miles)  of  perspiratory  chan- 
nel, its  unnumbered  nerve-ends,  it  is  one  of  the  most 
wonderful  and  important  organs  in  the  human  body.  It 
serves  as  a  tegument  to  protect  the  internal  parts  ;  it  is 
an  excretory  organ  second  only  to  the  kidneys  ;  it  is  an 
organ  of  perception — by  the  tactile  sensibility  of  the  skin 
man  largely,  unconsciously,  estimates  his  relation  to  the 
outside  world. 

The  great  extent  of  this  superficial  organ,  its  sensi- 
bility, its  extensive  communication  through  nerves  with 
brain-and-spine,  all  enable  us  to  powerfully  influence  the 
organ  of  vitality  through  the  skin. 

BATHS  may  be  made  of  great  value  to  the  nervous. 

The  cold  sponge  bath  (which  requires  only  a  large  bath 
sponge,  a  bowl  of  water,  and  a  piece  of  oil-cloth)  taken 
immediately  on  getting  out  of  bed,  and  lasting  perhaps  a 
minute,  is  a  valuable  tonic,  and  is  as  strong  a  form  of 
cold  bathing  as  is  advisable  in  many  cases.  In  persons 
who  have  plenty  of  blood,  the  cold  shower,  or  the  plunge 
bath,  taken  in  early  morning  or  in  mid-forenoon,  may  be 
better. 

Many  persons  make  too  long  a  use  of  the  cold  bath.  A 
half  minute,  or  a  single  minute,  spent  in  passing  the 
sponge  over  the  limbs,  chest  and  spine,  followed  by 
vigorous  rubbing  with  a  coarse  towel,  will  often  result  in 
a  fine  reaction  and  a  warm  glow,  when  five,  or  even  two 
minutes  would  be  too  long.  The  danger  in  the  cold  bath 

10  ( 145 ) 


146  NERVE    WASTE. 

is  in  cooling  the  body  below  the  normal  (98.6°)  tempera- 
ture, and  thus  depressing.  When  the  body  temperature 
has  been  raised  above  the  normal,  cold  may  be  applied 
without  danger  down  to  98.6°.  We  read  that  the  Russian 
will  emerge  from  his  hot  vapor  bath  and  roll  himself  in 
the  snow. 

This  question  of  cold  bathing  is  to  be  decided  by  the 
effects  which  it  produces;  if  the  individual  comes  to  the 
breakfast  table  after  his  sponge,  sheet,  or  shower  bath, 
warm  and  glowing,  the  bath  has  done  good,  but  if  the 
flesh  is  cooler  than  before  the  bath,  or  if  a  feeling  of  slight 
chilliness  is  experienced,  the  cold  bath  has  done  harm. 

There  are  doses  of  cold  bathing,  as  well  as  of  other 
remedies,  which  must  be  regulated  by  the  powers  of  the 
individual.  In  some,  generally  thin  persons,  any  form  of 
cold  bathing  has  a  depressing  effect,  and  is  inadmissible. 

Sea  Bathing,  as  a  remedy,  ranges  all  the  way  from  a 
powerful  tonic  to  a  powerful  depressant,  according  to  cir- 
cumstances; as  a  rule  it  is  not  adapted  to  thin  or  to  weak 
persons.  By  the  robust  it  is  often  overdone  and  made  to 
produce  depression  rather  than  elevation  of  the  vital 
powers.  I  advise  my  reader  to  be  guided  by  medical 
advice  before  resorting  to  this  form  of  bathing.  The  hot 
sea-water  baths,  to  be  found  at  most  -seaside  resorts,  are 
much  more  useful,  in  a  large  proportion  of  cases,  than 
open  sea  bathing. 

The  warm  (96°  to  104°)  or  hot  (lof  to  nf}  bath  is 
safer  for  the  thin  and  the  enfeebled  than  the  cold  bath;  they 
do  not  abstract  heat  from  the  body  as  the  cold  bath  does. 
The  popular  impression  is  that  warm  baths  are  weaken- 
ing, and  this  is  true  if  they  are  too  prolonged.  But  a  five 
minutes'  hot  bath,  to  which  two  tablespoonfuls  or  more 
of  salt  or  mustard  has  been  added,  acts  as  a  tonic,  and 
produces  better  effects  in  many  persons  than  the  cold  bath. 

Artificial  hot  sea-water  baths  may  be  improvised  at 
home  by  adding  3  per  cent  of  salt  to  the  bath — nine 


SURFACE    REMEDIES.  147 

pounds  of  salt  to  thirty  gallons  of  water.  Ditman's  Sea 
Salt  may  be  had  of  the  druggist  in  five-pound  boxes ; 
ordinary  rock-salt  will  do  very  well,  though  it  is  more  or 
less  dirty  and  the  resulting  water  needs  straining. 
Various  substances  are  added  to  the  hot  bath  for  the  pur- 
pose of  rendering  it  stimulating  or  tonic  instead  of  weaken- 
ing. Chopped  sea-weed  or  a  decoction  of  sea- weed  makes 
the  Fucus  bath  or,  as  it  is  called  in  England,  the  Ozone 
bath.  The  Pine  bath,  prepared  by  dissolving  one  half  to 
one  pound  of  the  extract  of  pine-needles  in  warm  water 
is  in  use  in  the  German  institutions.  The  essence  of  pine- 
needles  added  in  small  quantity  to  a  warm  bath  floats  on 
the  surface  of  the  water  and  clings  to  the  person  on  leav- 
ing the  bath,  enveloping  it  in  an  agreeable  aroma.  The 
extract  of  aromatic  herbs  (one  pound  to  a  bath),  chamo- 
mile,  gentian,  calamus,  mint,  juniper,  marjorurn,  clover- 
blossoms,  etc. ,  is  also  used  in  Germany  to  render  the  warm 
bath  stimulating. 

The  alternating  Hot  and  Cold  Salt  Sponge  Bath  is  one 
that  I  frequently  recommend.  A  large  bath  sponge  is 
alternately  loaded  with  hot  and  with  cold  salt  water 
and  expressed  over  limbs,  trunk,  and  especially  over  the 
spine.  Begin  with  the  hot  water  and  end  with  either  hot 
or  cold,  as  most  agreeable.  This  bath,  lasting  two  to  five 
minutes,  is  a  powerful  tonic. 

All  but  complete  immersion  in  a  hot  bath,  to  which  a 
handful  of  powdered  mustard  has  been  added,  has  served 
me  well  against  sleeplessness.  In  a  half  or  two- thirds  full 
bath-tub  one  may  so  arrange  himself  that  nostrils  and  mouth 
or  the  nostrils  alone  are  the  only  parts  of  the  surface  out  of 
water;  the  extensive  sedative  and  blood-diverting  influ- 
ence of  this  bath  powerfully  calms  an  irritated  nervous 
system.  Two  to  five  minutes  is  long  enough.  Of  course 
such  a  bath  would  not  be  advisable  in  cases  of  weak  or 
fatty  heart,  and  is  not  to  be  made  use  of  alone  by  very 
debilitated  persons. 


148  NERVE    WASTE. 

The  Vapor  (Russian)  and  the  Hot-Air  (Turkish)  baths 
are  useful  in  certain  cases  as  a  powerful  remedy  against 
sleeplessness,  but  these  baths. have  their  dangers,  and 
more  than  any  other  form  of  bathing  need  to  be  directed 
by  the  physician.  In  them  the  body  is  subjected  to  a 
heat  of  from  113°  to  (in  some  cases)  140°  or  more.  A  va- 
por bath  may  be  taken  at  home  by  placing  a  shallow  ves- 
sel of  boiling  water  under  a  chair,  adding  one  or  two  hot 
bricks  and  enveloping  the  body  seated  upon  the  chair 
with  blankets.  Vapor  baths  are  sometimes  rendered  more 
stimulating  or  agreeable  by  passing  the  steam  through 
bunches  of  fresh  aromatic  herbs  or  by  adding  pine-needle 
extract  or  Canada  balsam  to  the  water. 

Local  Bathing  of  various  kinds  is  a  remedy  of  the 
highest  value  in  the  various  phases  of  nervous  impair- 
ment ;  as  a  means  of  local  treatment  hot  water  is  greatly 
superior  to  cold. 

In  the  various  weaknesses  and  congestions  about  the 
female  reproductive  organs,  the  local  use  of  medicated 
hot  water  is  more  efficacious  than  any  other  single  rem- 
edy ;  and  in  the  various  irritations  and  relaxations  about 
the  male  reproductive  organs  I  use  hot  medicated  solu- 
tions, externally  and  also  internally,  by  means  of  certain 
contrivances,  with  the  best  results.  Weak  and  irritable 
eyes  are  generally  more  benefited  by  hot  or  warm  washes 
than  by  the  cold  ones  so  often  recommended.  When  a 
weakened  nervous  system  includes  among  its  other 
enemies,  some  chronic  inflammatory  process  about  the 
nasal  and  other  upper  air  passages,  hot  medicated  solu- 
tions and  sprays  form  an  important  element  in  the  treat- 
ment. 

In  certain  catarrhal  conditions  of  the  stomach,  as  well 
as  in  other  forms  of  dyspepsia,  washing  out  the  stomach 
with  various  medicated  waters  by  means  of  a  long  flexible 
tube  is  of  great  benefit;  this  lavage  is  more  used  by  Euro- 
pean physicians  than  by  Americans. 


SURFACE    REMEDIES.  149 

HEAT  AND  COLD  are  forces  of  great  power  in  many  of 
the  symptoms  of  nervous  impairment.  One  who  is  liable 
to  any  form  of  neurasthenic  pain  should  have,  and  es- 
pecially carry  with  him  when  he  goes  from  home,  two 
large  rubber  bottles  for  hot  water  which  may  be  applied 
to  feet,  abdomen,  spine  or  face  in  different  cases.  Heat 
to  the  small  of  the  back  is  a  powerful  stimulus  to  the  cir- 
culation and  may  be  employed  against  '  'a  cold' '  or  any  con- 
dition of  depression.  A  small  can  of  powdered  mustard, 
with  which  and  a  handkerchief  a  powerfully  sedative  ap- 
plication can  be  made  in  half  a  minute,  and  an  alcohol 
lamp  should  form  part  of  the  armamentarium  of  the  neu- 
rasthenic on  his  travels.  Pain  can  sometimes  be  ironed 
out  of  a  face,  neck  or  limb  by  means  of  a  hot  flat-iron 
and  a  piece  of  flannel.  Kvaporating  lotions  of  any  alco- 
holic liquid  and  water,  so  commonly  used  in  headache, 
are  only  a  means  of  producing  cold;  cloths  wrung  in  ice- 
water  are  preferred  by  some.  A  hollow  helmet  filled  with 
ice-water  is  part  of  a  plan  of  treatment  of  St.  Vitus' 
dance  recently  praised  by  Dr.  Corning  of  New  York; 
this  refrigeration  of  the  scalp,  used  in  connection  with  the 
galvanic  current,  contracts  the  brain- vessels  and  secures 
the  brain  rest  for  which  Dr.  Corning  has  long  been  so  able 
a  pleader.  Ice-bags  over  brain-and-spine,  gradually  con- 
tracting and  expelling  blood  from  the  vessels  of  the  cen- 
tral nervous  system,  constitutes  a  successful  treatment  of 
many  nervous  symptoms,  of  which  the  philosophy  has 
been  ably  taught  by  Dr.  John  Chapman  of  Paris.  The 
permanent  arrest  of  neuralgic  pain  by  means  of  intense 
cold  (produced  by  the  application  of  chloride  of  methyl) 
is  reported  by  certain  French  physicians.  Cold,  locally 
applied,  is  sometimes  of  great  service  against  deep  re- 
productive congestions  in  either  sex;  thus  the  "psy- 
chrophor,"  or  cold  carrier,  of  Winternitz  of  Vienna,  a 
hollow  blind  tube,  through  which  a  current  of  ice- water 


150  NERVE    WASTE. 

is  passed  from  a  high  reservoir,  is  a  powerful  measure 
against  deep  urethral  and  prostatic  congestion. 

COUNTER-IRRITATION,  influencing  the  nerve  sources  by 
means  of  stimulants  applied  to  the  nerve-ends,  has  been 
in  use  from  the  dawn  of  history,  and  is  practised  by  the 
most  primitive  peoples.  A  mustard  poultice,  a  spice- 
bag  or  a  plaster  which  relieves  deep-seated  pain,  conges- 
tion, or  inflammation,  is  popularly  supposed  to  act  by 
"drawing  out"  the  soreness  or  the  inflammation.  In 
this,  as  in  hundreds  of  other  medical  phenomena,  inex- 
perience observes  correctly  enough,  but  deduces  incor- 
rectly. The  physiology  of  counter-irritation  includes 
the  stimulated  nerve-end,  the  in-going  sensation-bearing 
nerve,  the  ultimate  receptive  and  reactive  nerve-centre, 
the  out-coming  impulse-bearing  nerve-fibre,  and  the  deep 
tissues — relaxed  or  contracted,  soothed  or  stimulated 
according  to  circumstances.  The  essential  factors  in 
counter-irritation  are  the  nerve-centres  of  brain-and-spine 
and  sympathetic.  In  deep-seated  irritations,  congestions, 
relaxations,  inflammations,  counter-irritation  is  still  one 
of  the  most  efficacious  procedures.  Rubefacients,  the 
galvano-cautery,  and  the  thermo-cautery,  never  pushed 
so  far  as  to  injure  the  skin  or  to  cause  much  pain,  are 
especially  useful  in  certain  spinal  and  deep  reproductive 
disorders 

Counter-irritation  is  one  of  the  oldest  procedures  against 
pain.  Equal  parts  of  camphor  and  chloral-hydrate  rubbed 
together  will  form  a  liquid,  which  is  of  great  service  as  a 
liniment  in  neuralgia.  L,iniments  containing  chloroform, 
aconite,  alcohol,  tincture  of  cayenne-pepper,  menthol  and 
alcohol  are  much  used.  A  mustard  plaster,  or  spongio- 
piline  wrung  out  in  hot  water  and  sprinkled  with  the 
compound  liniment  of  mustard,  and  even  flying  blisters  not 
larger  than  a  quarter  of  a  dollar  over  the  painful  point  are 
often  highly  effective. 


SURFACE    REMEDIES.  15! 

MASSAGE  is  a  word  derived  from  a  Greek  word,  signi- 
fying to  press,  knead,  or  handle.  Massage  is  one  of  the 
oldest  remedies  in  existence  ;  from  time  immemorial, 
shampooing,  rubbing,  flagellation,  and  other  manual  pro- 
cedures have  been  used  in  the  orient,  and  among  various 
uncivilized  races.  Modern  medicine  makes  a  considerable 
use  of  this  agent.  The  chief  procedures  of  massage  are — a 
gentle  stroking  toward  the  heart — effleurage  ;  a  vigorous 
rubbing — massage  a  friction;  a  pinching  of  the  muscles — 
petrissage  ;  and  a  tapping  or  percussion  of  the  muscles 
and  flesh — tapotement. 

The  effects  of  these  various  operations  may  be  sum- 
marized as  follows  : 

1.  They  increase  the  circulation  and  activity  of  the 
skin,  thus   enabling  it  to  better  perform  its  function  of 
sweating  out  excrementitious  substances  from  the  blood. 

2.  They   improve   the  nutrition  of  the  tissues  lying 
immediately  under  the  skin;  this  fatty  layer  is  increased, 
and  thus  the  body  improves  in  weight  and  appearance. 

3.  They  equalize  the  circulation,  drawing  blood  away 
from  the  brain  or  from  internal  organs,  thus  relieving  in- 
ternal congestions. 

4.  They  produce   a  distinct  sedative  or  tonic  effect 
upon  the  terminations  of  the  nerves,  the  end  organs  of 
the  nervous  system,  and  thus  exert  a  good  effect  upon 
the  central  nervous  tissues. 

Massage  will  often  induce  sleep  in  the  sleepless,  or 
replace  the  intolerable  feeling  of  fatigue  of  which  some 
patients  complain,  by  a  feeling  of  warmth  and  comfort. 
It  is  sometimes  possible  to  stroke  away  a  headache  or 
neuralgia  as  though  by  magic.  In  various  affections  of 
the  joints  and  muscles,  as  rheumatism,  massage  is  the 
most  valuable  remedy.  The  effects  of  massage  described 
above  are  part  of  the  secret  of  the  '  'magnetic  healing' '  so 
much  in  vogue.  The  magnetic  healer  is  generally  a 


152  NERVE    WASTE. 

person  who  makes  an  ignorant  and   unscientific  use  of 
massage;  they  often  overdo  it  and  thus  produce  injury. 

There  are  at  the  present  day,  in  all  large  cities,  a  class 
of  men  and  women  who  have  been  trained  in  this  art, 
and  the  services  of  these  masseurs  and  "masseuses  are  often 
utilized  by  the  physician,  and  not  a  few  physicians  make 
personal  use  of  massage  as  adjuvant  to  other  remedies. 

In  thin,  badly -nourished  infants,  a  daily  rubbing  with 
cod-liver,  or  some  other  oil,  for  half  an  hour,  will  produce 
great  benefit ;  they  improve  in  weight  and  appearance 
almost  immediately. 

CLOTHING  has  an  important  bearing  on  nervous  impair- 
ment. Those  whose  vitality  is  diminished,  whose  resis- 
tant or  re-active  powers  to  cold  are  deficient,  easily  "take 
cold' ' .  My  neurasthenic  patients  are  constantly  taking 
cold.  Taking  cold  is  a  purely  nervous  (vaso-motor) 
phenomenon.  A  draft  strikes  the  surface,  or  a  cold  damp 
air  chills  it;  the  nervous  mechanism  of  the  sympathetic 
contracts  the  vessels  of  the  skin  temporarily  suspend  its 
function  of  excreting  (perspiration)  and  throw  a  dispro- 
portionate part  of  the  blood  stream  upon  certain  internal 
organs.  The  blood  thus  precipitated  internally  is  not  a 
pure  blood;  it  is  a  blood  which  has  failed  in  relieving 
itself,  in  the  skin,  of  certain  excrementitious  substances. 

Perspiration  is,  to  some  extent,  an  excretion  like  urine; 
it  is  one  of  the  fluids  in  which  the  body  washes  out  its 
waste  materials.  Every  household  produces  a  certain 
quantity  of  garbage,  which  is  promptly  and  regularly  re- 
moved; when,  as  recently  happened  in  this  city,  the 
scavengers  go  on  a  "strike,"  a  short  accumulation  is  of- 
fensive and  unwholesome.  The  function  of  perspiration, 
to  which  modern  physiologists  attach  the  greatest  im- 
portance, is  regulation  of  the  bodily  heat.  It  is  largely 
by  evaporation  of  sweat  that  the  body  is  steadily  main- 
tained at  a  uniform  temperature.  When  sweat  fails  the 
internal  heat  point  is  raised  above  the  normal  and  internal 


SURFACE    EEMEDIES  153 

fever  occurs.  In  temperate  weather  an  adult  perspires 
about  two  pints  in  twenty-four  hours.  In  a  Turkish  bath 
the  body  can  lose  two  pints  of  sweat  in  a  single  hour. 
*  'Sensible"  perspiration  occurs  when  drops  appear  upon 
the  skin:  insensible  perspiration  is  going  on,  in  places, 
continuously.  The  physiologies  used  to  record  the  story 
of  a  child  who  was  gilded  all  over,  to  represent  an  angel 
in  a  papal  festival  at  Rome,  and  who  died  in  four  hours, 
from  suppression  of  this  excreting  and  heat-evaporating 
function. 

When  a  cold  drives  back  an  excess  of  impure  blood 
from  the  surface  it  is  not  accommodated  by  all  internal 
organs  equally,  but  largely  by  certain  tissues  which 
seem  to  have  a  compensatory  or  complementary  relation 
to  the  skin.  The  blood-wave  rejected  from  the  skin  by  a 
cold  does  not  often  "settle"  in  bone  or  ligament  or  brain, 
but  is  very  apt  to  engorge  nasal,  bronchial  or  intestinal 
mucous  membrane.  Any  internal  mucous  surface  which 
has  been  diseased,  and  thus  weakened  and  rendered  less 
resistant,  is  liable  to  feel  the  effects  of  a  cold;  even  the  ure- 
thra in  certain  chronic  cases  is  a  perfect  barometer;  in 
others  the  spine  is  very  sensitive  to  cold. 

For  several  reasons  the  nervous  should  wear  woolen 
under-garments.  Wool  protects  against  draughts,  it 
absorbs  moisture  (perspiration),  it  absorbs  odors,  keeps 
the  flesh  sweet-smelling,  and  exerts  a  gentle  stimulating, 
derivative  influence  on  the  surface  which  favors  excre- 
tion and  softly  counter-irritates  brain-and-spine.  Those 
who  are  subject  to  bronchitis  may  advantageously 
wear  a  second  woolen  under-garment  in  the  form  of  a 
vest:  this  complete  chest-protector  is  perfect  where  the 
front,  or  front  and  back,  (side  neglecting)  protectors  ordi- 
narily sold  are  very  imperfect.  In  spinal  irritation  and 
other  spinal  disorders,  a  broad  band  of  flannel  about  the 
loins  gives  great  comfort  and  wards  off  many  an  ache;  I 
have  known  such  a  band  to  cure  chronic  diarrhoea.  There 


154  NERVE    WASTE. 

is  no  such  thing  as  medicated  flannel:  red  flannel  has  no 
advantage  and  some  disadvantages  over  white  or  gray. 
The  heaviest  men's  gray  Scotch  wool  under-garments  to 
be  had  at  men's  furnishing  stores,  re-inforced,  in  delicate 
persons,  by  an  undervest  of  Bulle  flannel,  are  excellent. 
Better  are  the  garments  of  the  Jaeger  Sanitary  Woolen 
System  Co.  (N.  Y.),  which  are  now  to  be  had  in  most 
large  cities.  Dr.  Jaeger  would  have  us  discard  cotton, 
linen  and  silk  and  dress  altogether  in  wool,  from  hat  to 
boot,  and  even  sleep  in  woolen  sheets,  under  woolen 
blankets  and  counterpanes.  This  idea,  which  seems  ex- 
treme at  first  sight,  is  supported  by  good  reasons  and  by 
experience. 

The  little  plug  of  cotton  in  the  ears — when  one  is 
driving  in  the  wind  or  has  a  sore  throat — wristlets,  felt 
slippers  and  cork-sole  shoes  all  afford  protection  or  com- 
fort in  certain  cases. 


XXVI 

THE    SURGICAL    TREATMENT    OF    NERVOUS    IMPAIRMENT 

The  fact  lias  been  more  than  once  noted,  that  in  certain 
cases  of  nervous  impairment  the  skill  of  the  surgeon  must 
accompany  the  wisdom  of  the  physician.  When  a  chronic 
i.e.,  thoroughly  established,  disease-process  is  acting  back- 
wards to  irritate  and  depress  the  brain-and-spine,  its 
removal  is  the  first  thing  in  order.  Sometimes  this  may 
be  effected  by  hygiene  and  medication  ;  more  often  it 
requires  direct  local  treatment. 

When  hurtful  tension  of  one  or  more  of  the  ocular  mus- 
cles involving  eye-strain,  and  thus  brain-strain — tenot- 
omy — division  of  the  taut  muscle  has  produced  brilliant 
results  in  epilepsy. 

In  hay  fever,  asthma,  and  chronic  nasal  catarrh  irrita- 
tions about  the  nose  and  upper  air  passages  can  sometimes 
only  be  cured  surgically.  The  five  indications  in  the  local 
treatment  of  chronic  nasal  catarrh  are  cleansing  of  the  dis- 
eased surface,  disinfection,  soothing  or  stimulating  the 
mucous  membrane,  reduction  of  engorgement  and  conges- 
tion, and  removal  of  redundant  and  diseased  tissue.  When 
the  last  of  these  indications  exists  some  surgical  procedure 
•^the  cautery,  the  galvano-cautery,  the  snare,  the  curette 
or  the  knife — is  the  only  certain  resource.  As  an  eminent 
rhinologist,  in  summing  up  the  modern  treatment  of 
chronic  catarrhal  disorders,  recently  said:  "  The  sooner  we 
cease  to  be  throat  doctors  and  become  throat  surgeons  the 
better  will  be  our  success  in  the  management  of  diseases 
of  the  upper  air  passages. ' ' 

The  surgical  treatment  of  neuralgia  is  all  that  remains 
in  some  cases.  It  includes  acupuncture — thrusting 

(155) 


156  NERVE   WASTE. 

needles  beneath  the  surface — the  injection  of  various  solu- 
tions deep  into  the  tissues  and  alongside  the  nerve,  nerve- 
stretching,  and  nerve-section.  All  these  operations  are 
successful  in  certain  cases,  but  the  result  cannot  be  posi- 
tively promised  in  any  single  case. 

It  is  a  singular  fact  that  a  surgical  operation  of  itself, 
without  any  special  indication,  will  sometimes  arrest  ner- 
vous disorders  for  years,  or  even  cure  them  altogether. 
The  operation  of  trephining  the  skull  for  epilepsy  under- 
taken in  the  supposition  that  depressed  bone  is  irritating 
the  brain-surface,  is  often  successful  in  curing  the  disease 
when  no  depression  is  found.  The  operation  of  ocular 
tenotomy  in  epilepsy,  and  the  operations  against  neuralgia 
probably  act  in  the  same  way,  in  a  few  cases,  by  the  pro- 
found impression,  or  the  counter-irritating  effect  which  is 
thus  produced  upon  the  central  nervous  structures. 

In  many  cases  of  nervous  disease  in  children  the  opera- 
tion of  circumcision,  or,  what  I  often  prefer,  that  of  prepu- 
tial  dilation,  will  effect  a  radical  cure.  It  seems  supererog- 
atory to  assert  that  a  natural  oi»gan,  placed  by  the  Creator, 
is  superfluous,  and  should  be  removed.  But  no  fact  in 
neurology  is  better  established  than  that  the  foreskin  in 
sedentary  neurotic  children  may  be  an  irritant,  and  a  cause 
of  extreme  nervous  disease.  In  sexual  neurasthenia, 
when  urethral  and  prostatic  morbid  changes  are  present, 
but  little  progress  can  be  made  until  these  are  removed. 

In  every  large  community  there  is  a  certain  proportion 
of  ca"ses~of  ovarian  jlisease  which  have  exhausted  the 
ordinary  resources  of  medicine  and  surgery,  without 
benefit,  and  in  which  life  has  become  a  burden.  It  was 
in. this  class  ot  cases  that  removal  ot  the  offending  organs 
_was  first  practised  with  brilliant  results.  Since  that  time 
the  operation  of  ablation  of  the  ovaries  has  been  abused 
(what  good  thing  has  not  ?}  and  medical  men  are  ranged 
pro  and  con.  This  operation  has  not  yet  become  estab- 
lished  among  the  medical  profession  at  large,  but  has 


THE    SURGERY    OF    NERVOUS    IMPAIRMENT.  157 

so  among  specialists  in  abdominal  surgery.  There  is 
abundant  proof  that  this  operation  is  a  blessing  in  suitable 
cases,  but  there  is  also,  unfortunately,  abundant  proof 
that  the  good  judgment  which  confines  operating  to 
suitable  cases  is  not  common. 

In  all  surgery  good  judgment  must  precede  skill; 
indeed,  if  one  must  be  lacking  I  should  in  my  own 
person,  prefer  less  skill  and  more  judgment.  The  readi- 
ness, even  eagerness,  of  surgeons  as  a  class  to  operate 
leads  the  laity  to  suspect  some  secret  anatomical  paranoia 
akin  to  that  of  '  'Jack  the  Ripper, ' '  but  man  loves  to  do 
that  which  he  can  do  skillfully  and  this  penchant  leads  to 
much  needless  operating . 

An  immense  amount  of  local  treatment  is  conceived  and 
carried  out  in  dishonesty.  Every  physician  has  seen 
patients  who  have  been  subjected  to  long  and  expensive 
courses  of  local  treatment  for  which  there  was,  to  say  the 
least,  no  legitimate  indication.  Some  patients  even  de- 
velop a  kind  of  mania  for  local  treatment;  "folic  gyna- 
cologique" — broadly  "womb-doctoring  foolishness,"  is  a 
French  term  which  might  be  paraphrased  and  become 
useful  in  America.  An  eminent  surgeon  recently  re- 
marked, "the  favorite  hunting  ground  of  quackery  is  an 
obscure,  mysterious,  mucous  canal" — where  disease  may 
be  imagined  but  cannot  be  demonstrated.  The  urethra, 
the  rectum  and  the  womb  are  constantly  treated  for 
imaginary  diseases,  and  an  imaginary  disease  is  often 
more  injurious  to  vitality  than  a  real  one. 


XXVII 

APHORISMS    IN    NERVOUS  IMPAIRMENT 

1.  The  brain-and-spine  is  the  organ  of  vitality. 

2.  The  brain-and-spine  may  be  crippled  by  any  form 
of  functional  over-activity — wear,  tear,  strain,  wrench,  or 
over-draft — as  certainly  as  the  ankle-joint  may  be. 

3.  The  manifestations  of  brain-  and-spinal  impairment 
are  partly  objective,  but  largely  subjective. 

4.  The  signs  of  distress  which  a  crippled  brain-and- 
spine   hangs   out  are  the  most  heed-worthy  of  all  morbid 
signs. 

5.  Many  cases  of  nervous  impairment  are  incurable  in 
their  earlier  stages,   but   become  curable  in  a  later  stage, 
after   the  subject  has  gotten  very  much  worse;  a  period 
of  suffering  is  sometimes  necessary  before  true  remedies 
will  be  permitted. 

6.  The  cure  of  nervous  impairment  is  a  combination 
cure,  including  many  forces  in  proper  proportion.     It  is  a 
chain  of  which  one  broken  link  throws  the  whole  to  the 
ground. 

7.  Natural  remedies — rest,  sleep,  food,  out-of-door  air, 
cheerfulness — are  more  efficacious  than  drugs. 

8.  Rest — nerve  economy — in  large  or  in  small  doses, 
is  in  most  cases  an  essential  remedy. 

9.  Oxygen  gas  in  the  form  of  out-door  air  is  incom- 
parably the  most  powerful  known  tonic  and  vitalizer  to 
the  nervous  tissues — in  the  quickness  and  certainty  of  its 
action,  and  in  the  permanence  of  its  results. 

10.  Nerve  nutrition  requires  a  rich  blood-stream,  and 
hungry,  unfagged,  actively  assimilating  nerve-cells.    The 

(158) 


APHORISMS   IN   NERVOUS   IMPAIRMENT.  159 

four  factors  of  assimilative  (force-creating)  and  force- 
supplying  vigor  in  the  nerve-cells  are  daily  food,  daily 
oxygen,  daily  work  and  daily  rest,  in  proportions  that 
vary  with  circumstances.  Oxygen  is  the  essential  ele- 
ment of  the  fire  of  life  as  it  is  of  all  fire;  a  blood- stream 
fully  charged  with  oxygen  gas  by  deep-breathing,  full 
and  free  lung-play,  is  from  ten  to  an  infinite  number  of 
times  more  nourishing  to  brain  and  nerves  than  a  blood- 
stream loaded  with  hypophosphites  and  lacking  in  oxy- 
gen. 

11.  Brain  and  nerve  foods  are  useful  as  far  as  they 
are  assimilated  by  brain  and  nerve-cells,  and  not  farther. 

12.  Of  the  three  great  classes  of  foods — starches  and 
sugars,  fats  and  albumens  or  nitrogenized  foods — the  last 
two  are  essential  to  develop  and  maintain  stability,  endur- 
ance and  reserve  power  in  the  nervous  structures  of  the 
nineteenth  century  American. 

13.  A  nervous  cripple  with  a  thoroughly  imcompetent 
liver  is  like  a  steam  boiler  which  has  been  condemned; 
both  can  only  run  at  very  low  pressure. 

14.  Medicines  are  valuable  remedies  in  nervous  im- 
pairment, but  their  place  is  secondary  and  assistant.     Of 
themselves,  and  without  a  foundation  of  other  remedies, 
they  are,  in  most  cases,  powerless  to  cure. 

15.  The  nervous  system,  like  the  eye,  is  not  a  good 
part  of  the  body  for  amateur  prescribers  to  experiment 
with;  unskillful  drugging  is  apt  to  be  useless  or  worse. 

1 6.  When  a  chronic,  local  morbid  process  is  at  the 
bottom  of,  or  complicates,  nervous  impairment,  the  affec- 
tion may  resist  every  kind  of  general  treatment  until  the 
local  disorder  is  removed. 

17.  Electricity  used  according  to  the  principles,  the 
nerve-routes,    and  the  dosage  of  modern  electro- thera- 
peutics is  one  of  the  most  efficacious  remedies  against 
both  the  general  and  local  phases  of  nervous  impairment. 

1 8.  Rest,  change,  sleep,  out-of-door  air,  baths,  food, 


I6O  NERVE   WASTE 

phosphorus,  strychnine,  quinine,  iron,  alcohol,  electricity, 
massage,  and  every  other  remedy  which  experience  has 
shown  to  be  good  in  nervous  impairment,  may  be,  and 
often  is,  so  used  as  to  aggravate  the  disorder  and  make 
the  patient  worse. 

19.  Rest,  feeding,  trouble,  sacrifice,  expense  must  be 
proportionate  to  the  needs  of  the  case;  if  these  fall  short 
or  over-reach  the  cure  is  apt  to  be,  so  far,  a  failure. 

20.  Proportioning — the  adaptation  of  restorative  forces 
to  morbid  needs — and  authority — the  vis  externus  which 
maintains  proportion — often  constitute   the  great  power 
and  use  of  the  physician  in  nervous  impairment. 


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